Related Experiment Video
Updated: Oct 23, 2025
Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
Novel Composite Endpoint for Assessing Outcomes in Liver Transplantation: Arterial and Biliary Complication-Free
Eric Savier1, Yann De Rycke, Chetana Lim
1Service de Chirurgie Digestive Hépato-Bilio-PancréatiqueTransplantation HépatiqueCentre Hospitalo-Universitaire Pitié-SalpêtriereAssistance Publique-Hôpitaux de Paris Sorbonne Université Paris France Centre de Recherche Saint-AntoineUnité Mixte de Recherche Scientifique-938Institute of Cardiometabolism and Nutrition Sorbonne UniversitéInstitut National de la Santé et de la Recherche Médicale Paris France Institut Pierre Louis d'Epidémiologie et de Santé Publique Sorbonne UniversitéInstitut National de la Santé et de la Recherche Médicale Paris France Département de Santé Publique Assistance Publique-Hôpitaux de ParisHôpital Pitié SalpêtrièreSorbonne Université Paris France Centre de Pharmacoépidémiologie (Cephepi) CHU Pitié-Salpêtrièrere, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université Paris France Département d'Informatique Médicale Assistance Publique-Hôpitaux de ParisHôpitaux Universitaires Pitié Salpêtrière-Charles FoixSorbonne Université Paris France Centre Hépato-Biliaire Assistance Publique-Hôpitaux de Paris Hôpital Paul Brousse Villejuif France Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation Hospital Universitari de BellvitgeInstitut d'Investigacio Biomedica de Bellvitge Barcelona Spain.
Insights
Arterial or biliary complications (ABC) within the first year after liver transplantation (LT) significantly impact transplant and patient survival. Arterial and biliary complication-free survival (ABCFS) is a reproducible metric for LT outcomes.
Area of Science:
- Hepatology
- Transplantation Surgery
- Clinical Outcomes Research
Background:
- Liver transplantation (LT) success is typically measured by transplant and patient survival.
- Arterial and biliary complications (ABC) are significant adverse events following LT.
- Assessing novel metrics for LT outcomes is crucial for improving patient care and research.
Purpose of the Study:
- To evaluate arterial and biliary complication-free survival (ABCFS) as a novel metric for assessing LT outcomes.
- To determine the prognostic value of early ABCs on long-term transplant and patient survival.
- To explore the correlation between ABCFS and established survival endpoints.
Main Methods:
- Defined ABC as Dindo-Clavien grade ≥III arterial or biliary complications requiring intervention.
- Calculated ABCFS as time from LT to first ABC, death, relisting, or last follow-up.
- Analyzed data from a primary LT cohort (n=532) and extended cohorts (n=658), including external validation cohorts.
- Utilized univariate and multivariate analyses to assess the impact of ABC on survival.
Main Results:
- The majority of ABCs (93%) occurred within the first year post-LT.
- First-year ABCs were independently associated with reduced transplant survival (HR 3.17) and patient survival (HR 2.7).
- ABCFS demonstrated strong correlation with transplant and patient survival (ρ=0.85 and ρ=0.81, respectively).
- 1-year ABCFS was indicative of 5-year transplant survival.
Conclusions:
- Arterial and biliary complication-free survival (ABCFS) is a reproducible and valuable metric for evaluating liver transplantation outcomes.
- Early post-transplant arterial and biliary complications are critical predictors of long-term survival.
- ABCFS shows potential as a new endpoint in clinical trials for liver transplantation.
Abstract:
Transplant and patient survival are the validated endpoints to assess the success of liver transplantation (LT). This study evaluates arterial and biliary complication-free survival (ABCFS) as a new metric. ABC, considered as an event, was an arterial or biliary complication of Dindo-Clavien grade ≥III complication dated at the interventional, endoscopic, or surgical treatment required to correct it. ABCFS was defined as the time from the date of LT to the dates of first ABC, death, relisting, or last follow-up (transplant survival is time from LT to repeat LT or death). Following primary whole LT (n = 532), 106 ABCs occurred and 99 (93%) occurred during the first year after LT. An ABC occurring during the first year after LT (overall rate 19%) was an independent factor associated with transplant survival (hazard ratio [HR], 3.17; P < 0.001) and patient survival (HR, 2.7; P = 0.002) in univariate and multivariate analyses. This result was confirmed after extension of the cohort to split-liver graft, donation after circulatory death, or re-LT (n = 658). Data from 2 external cohorts of primary whole LTs (n = 249 and 229, respectively) confirmed that the first-year ABC was an independent prognostic factor for transplant survival but not for patient survival. ABCFS was correlated with transplant and patient survival (ρ = 0.85 [95% CI, 0.78-0.90] and 0.81 [95% CI, 0.71-0.88], respectively). Preoperative factors known to influence 5-year transplant survival influenced ABCFS after 1 year of follow-up. The 1-year ABCFS was indicative of 5-year transplant survival. ABCFS is a reproducible metric to evaluate the results of LT after 1 year of follow-up and could serve as a new endpoint in clinical trials.
