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Mortality risk score in liver transplantation: changes over time in its predicting power
Mariana del Pino1, Guillermo Cervio, Marcelo Dip
1Growth and Development, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina. mdelpino@garrahan.gov.ar
Insights
A liver transplant risk score effectively predicted mortality in children initially. However, its predictive power diminished over time, necessitating updates as patient risk factors evolve.
Area of Science:
- Pediatric Hepatology
- Transplant Surgery
- Biostatistics
Background:
- Liver transplantation in children has advanced significantly since 1992.
- A need exists for tools to predict mortality risk in pediatric liver transplant recipients.
- Monitoring outcomes and refining predictive models are crucial for program improvement.
Purpose of the Study:
- To develop and validate a risk score for predicting mortality in pediatric liver transplant patients.
- To analyze changes in mortality rates over a 12-year period.
- To identify factors influencing these mortality changes.
Main Methods:
- Cox regression analysis was used on a retrospective cohort of 110 pediatric liver cirrhosis patients transplanted between 1992 and 2000.
- A risk score was created using age and bilirubin levels as significant predictors of survival.
- The score was applied to subsequent patient cohorts from 2000-2002 and 2002-2004.
Main Results:
- The initial risk score distinguished between low- and high-risk groups with significant survival differences (median survival: 93.13 vs. 2.93 months, p=0.0001) in the 1992-2000 cohort.
- In the 2000-2002 cohort, survival differences persisted (41.7 vs. 2.33 months, p=0.03).
- By 2002-2004, the score's discriminatory power decreased (p=0.35), with reduced mortality in the high-risk group, suggesting a changing risk landscape.
Conclusions:
- A risk scoring system is a valuable tool for stratifying risk in liver transplantation.
- The effectiveness of risk scores can decrease over time due to evolving risk factors and improved clinical management.
- Continuous re-evaluation and updating of risk assessment tools are essential in dynamic fields like pediatric liver transplantation.
Unlabelled:
Since the onset of our liver transplantation program in 1992, 362 transplants were performed in 338 children. A risk score for predicting mortality was designed and implemented over time. The description of a method utilized to design the risk score, changes in mortality rate over 12 yr and the analysis of factors that might have influenced these changes are presented and discussed in this paper.
Patients And Methods:
Cox regression analysis was applied to a retrospective sample of 110 patients with liver cirrhosis, transplanted between 1992 and 2000. A risk score was prepared using beta coefficients of the two significant variables related to survival time: age (1.08, p=0.02) and bilirubin levels (0.93, p=0.03), and two groups were identified: low- and high-risk score. The score was applied in two consecutive samples: 2000-2002 and 2002-2004.
Results:
In the first sample (1992-2000), we found 69 and 41 as low- and high-risk patients, with a median survival time of 93.13 and 2.93 months (p=0.0001). In the 2000-2002 sample, a median survival time of 41.7 and 2.33 months (p=0.03) was found for low- and high-risk groups, respectively. In the third sample (2002-2004), there was a remarkable decrease in mortality in the high-risk group (n=29) and the score did not discriminate between high- and low-risk groups (p=0.35).
Conclusion:
A scoring system to identify risk levels in liver transplantation patients is an operative and powerful tool during a given period of time but it has to be updated as risk factors will vary following the team's learning curve.
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