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Updated: Jul 28, 2026
Orthotopic Liver Transplantation in Rats
Published on: July 1, 2012
Estimating risk of prolonged mechanical ventilation after liver transplantation in children: PROVE-ALT score
Muhammad Umair M Mian1, Curtis E Kennedy2, Jorge A Coss-Bu2
1Division of Child Health, University of Missouri School of Medicine, Springfield Clinical Campus, Columbia, Missouri, USA.
Insights
A new score, PROVE-ALT, accurately predicts prolonged mechanical ventilation (PMV) in children after liver transplantation (LT). This tool helps optimize care and resources for high-risk pediatric LT patients.
Area of Science:
- Pediatric Surgery
- Critical Care Medicine
- Transplantation Medicine
Background:
- Identifying children at high risk for prolonged mechanical ventilation (PMV) post-liver transplantation (LT) is crucial for optimizing pulmonary support and surgical outcomes.
- Early risk stratification aids in resource allocation and tailored patient management strategies.
Purpose of the Study:
- To develop and validate a predictive metric, the PROVE-ALT score, for estimating the risk of prolonged mechanical ventilation after pediatric liver transplantation.
- To identify key preoperative risk factors associated with PMV in pediatric LT recipients.
Main Methods:
- A retrospective cohort study involving pediatric LT recipients (n=338) was conducted.
- Preoperative risk factors for PMV were identified using univariable analysis.
- The PROVE-ALT score was developed using multivariable logistic regression and validated in a separate cohort.
Main Results:
- The PROVE-ALT score demonstrated high accuracy in predicting PMV in the validation cohort (AUC: 0.81), with 73% sensitivity and 80% specificity.
- Independent risk factors for PMV included cirrhosis, age <1 year, need for preoperative continuous renal replacement therapy (CRRT), and pre-LT management in hospital (MIH).
- The PROVE-ALT score cutoff of ≥8 accurately predicted PMV.
Conclusions:
- The PROVE-ALT score is a sensitive and specific tool for predicting PMV in pediatric LT patients.
- External validation is recommended to facilitate its widespread clinical adoption.
- The PROVE-ALT score can guide patient-specific ventilation strategies, parental counseling, and resource optimization.
Background:
Children at high risk for prolonged mechanical ventilation (PMV) after liver transplantation (LT) need to be identified early to optimize pulmonary support, allocate resources, and improve surgical outcomes. We aimed to develop and validate a metric that can estimate risk for Prolonged Ventilation After LT (PROVE-ALT).
Methods:
We identified preoperative risk factors for PMV by univariable analysis in a retrospective cohort of pediatric LT recipients between 2011 and 2017 (n = 205; derivation cohort). We created the PROVE-ALT score by mapping multivariable logistic regression coefficients as integers, with cutoff values using the Youden Index. We validated the score by C-statistic in a retrospectively collected separate cohort of pediatric LT recipients between 2018 and 2021 (n = 133, validation cohort).
Results:
Among total 338 patients, 21% (n = 72) were infants; 49% (n = 167) had cirrhosis; 8% (n = 27) required continuous renal replacement therapy (CRRT); and 32% (n = 111) required management in hospital (MIH) before LT. Incidence of PMV post-LT was 20% (n = 69) and 3% (n = 12) required tracheostomy. Independent risk factors (OR [95% CI]) for PMV were cirrhosis (3.8 [1-14], p = .04); age <1-year (8.2 [2-30], p = .001); need for preoperative CRRT (6.3 [1.2-32], p = .02); and MIH before LT (12.4 [2.1-71], p = .004). PROVE-ALT score ≥8 [Range = 0-21] accurately predicted PMV in the validation cohort with 73% sensitivity and 80% specificity (AUC: 0.81; 95% CI: 0.71-0.91).
Conclusion:
PROVE-ALT can predict PMV after pediatric LT with a high degree of sensitivity and specificity. Once externally validated in other centers, PROVE-ALT will empower clinicians to plan patient-specific ventilation strategies, provide parental anticipatory guidance, and optimize hospital resources.
