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01.12.2014 | Original Article | Ausgabe 8/2014

Langenbeck's Archives of Surgery 8/2014

Value and limitations of the BAR-score for donor allocation in liver transplantation

Zeitschrift:
Langenbeck's Archives of Surgery > Ausgabe 8/2014
Autoren:
Harald Schrem, Anna-Luise Platsakis, Alexander Kaltenborn, Armin Koch, Courtney Metz, Marc Barthold, Christian Krauth, Volker Amelung, Felix Braun, Thomas Becker, Jürgen Klempnauer, Benedikt Reichert
Wichtige Hinweise
Both authors Harald Schrem and Anna-Luise Platsakis contributed equally to this paper.

Authorship

H. Schrem, A.L. Platsakis, A. Kaltenborn and B. Reichert designed and conceptualized the study. H. Schrem, A.L. Platsakis, A. Kaltenborn, J. Klempnauer and B. Reichert acquired the data. H. Schrem, A.L. Platsakis, A. Kaltenborn, A. Koch, C. Metz, M. Barthold, C. Krauth, V. Amelung, F. Braun, T. Becker, J. Klempnauer and B. Reichert analyzed and interpreted the data. H. Schrem, A.L. Platsakis, A. Kaltenborn, A. Koch, C. Metz, M. Barthold, C. Krauth, V. Amelung, F. Braun, T. Becker, J. Klempnauer and B. Reichertm drafted the manuscript. H. Schrem, A.L. Platsakis, A. Kaltenborn, A. Koch, C. Metz, M. Barthold, C. Krauth, V. Amelung, F. Braun, T. Becker, J. Klempnauer and B. Reichert critically revised the manuscript.

Abstract

Purpose

The MELD-score was shown to be able to predict 90-day mortality in most patients with end-stage liver disease prior to liver transplantation and is used as a widely accepted measure for transplantation urgency. Prognostic ability of the BAR-score to predict 90-day post-transplant mortality by detection of unfavourable pretransplant combinations of donor and recipient factors may help to better balance urgency versus utility.

Methods

Two German cohorts (Hannover, n = 453; Kiel, n = 234) were retrospectively analyzed using ROC-curve analysis, goodness-of-model-fit tests, summary measures and risk-adjusted multivariate binary regression. Included were all consecutive liver transplants performed in adult recipients (minimum age 18 years). Excluded were all combined transplants and living-related organ donor transplants.

Results

Risk-adjusted multivariate regression revealed that the BAR-score is an independent risk factor for 90-day mortality after transplantation in both cohorts from Hannover and Kiel combined (p < 0.001, OR = 1.017, 95 % CI:1.031–1.113). The area under the ROC-curve (AUROC) for the prediction of 90-day mortality using the BAR-score was 0.662 (95 % CI 0.624–0.699, power >95 %). Measures for association between observed 90-day mortality and the predicted probabilities in the combined cohort were concordant in 63.5 % with low summary measures (Somers’ D test 0.32, Goodman-Kruskal Gamma test 0.34 and Kendall’s Tau a test 0.07).

Conclusions

The BAR-score performed below accepted thresholds for potentially useful clinical prognostic models. Prognostic models with better predictive ability with AUROCs >0.700, concordance >70 % and larger summary measures are required for the prediction of 90-day post-transplant mortality to enable donor organ allocation with reliable weighing of urgency versus utility.

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