A model for calculating the long-term estimated post-transplant survival of deceased donor liver transplant patientsResearch in context
John S. Malamon,
Whitney E. Jackson,
Jessica L. Saben,
Kendra Conzen,
Jesse D. Schold,
James J. Pomposelli,
Elizabeth A. Pomfret,
Bruce Kaplan
Affiliations
John S. Malamon
Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, CO, USA; Corresponding author. Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
Whitney E. Jackson
Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, CO, USA; Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
Jessica L. Saben
Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, CO, USA
Kendra Conzen
Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, CO, USA
Jesse D. Schold
Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, CO, USA; Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
James J. Pomposelli
Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, CO, USA
Elizabeth A. Pomfret
Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, CO, USA
Bruce Kaplan
Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, CO, USA; Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
Summary: Background: The estimated long-term survival (EPTS) score is used for kidney allocation. A comparable prognostic tool to accurately quantify EPTS benefit in deceased donor liver transplant (DDLT) candidates is nonexistent. Methods: Using the Scientific Registry of Transplant Recipients (SRTR) database, we developed, calibrated, and validated a nonlinear regression equation to calculate liver-EPTS (L-EPTS) for 5- and 10-year outcomes in adult DDLT recipients. The population was randomly split (70:30) into two discovery (N = 26,372 and N = 46,329) and validation cohorts (N = 11,288 and N = 19,859) for 5- and 10-year post-transplant outcomes, respectively. Discovery cohorts were used for variable selection, Cox proportional hazard regression modeling, and nonlinear curve fitting. Eight clinical variables were selected to construct the L-EPTS formula, and a five-tiered ranking system was created. Findings: Tier thresholds were defined and the L-EPTS model was calibrated (R2 = 0.96 [5-year] and 0.99 [10-year]). Patients’ median survival probabilities in the discovery cohorts for 5- and 10-year outcomes ranged from 27.94% to 89.22% and 16.27% to 87.97%, respectively. The L-EPTS model was validated via calculation of receiver operating characteristic (ROC) curves using validation cohorts. Area under the ROC curve was 82.4% (5-year) and 86.5% (10-year). Interpretation: L-EPTS has high applicability and clinical utility because it uses easily obtained pre-transplant patients characteristics to accurately discriminate between those who are likely to receive a prolonged survival benefit and those who are not. It is important to evaluate medical urgency alongside survival benefit and placement efficiency when considering the allocation of a scarce resource. Funding: There are no funding sources related to this project.
