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21 July 2022 : Original article  

[In Press] Clinical Validation of a Novel Scoring System Based on Donor and Recipient Risk Factors for Predicting Outcomes in Liver Transplantation

Lucas Souto Nacif1ABCDEF, Daniel Reis Waisberg1CDE, Leonardo Yuri Zanini1BCDEF, Rafael Soares Pinheiro1ACD, Vinicius Rocha-Santos1ACD, Rubens Arantes Macedo1BD, Liliana Ducatti ORCID logo1BD, Luciana Haddad1BD, Rodrigo Bronze de Martino1ACDE, Flávio Galvão1AD, Wellington Andraus1ACD, Luiz Carneiro-D‘Albuquerque1AD

DOI: 10.12659/AOT.936271

Ann Transplant In Press; DOI: 10.12659/AOT.936271  

Available online: 2022-07-21, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule


Adequate donor and recipient matching in liver transplantation is crucial to improve patient survival. Our objective was to propose and validate a new model for predicting outcomes using donor and recipient scoring criteria.
We retrospectively analyzed data of all patients (n=932) who underwent liver transplantation (n=1106) from January 2006 to December 2018. For score standardization, 30% (n=280) of patients were randomly selected for analysis and divided into 3 categories: ≤4 points, 5 to 8 points, and >8 points. Scoring system validation was performed on a dataset with 70% (n=652) of the patients.
Survival of the stratified group (30%) was significant (P<0.001). Scores of 4 to 8 points presented lower risk of death (1.74 [CI 0.97-3.13; P=0.062]), while >8 points presented higher risk (2.74 [CI 1.36-5.57; P=0.005]). In the validation score (70%), global survival was significant (P<0.0016); patients with scores of 4 to 8 points had lower risk of death (1.16 [CI 1.16-2.38; P=0.005]); and scores >8 points (2.22 [CI 1.40-3.50; P<0.001]), retransplant, fulminant hepatitis, previous large abdominal/biliary tree surgery, MELD score, and serum creatinine before liver transplantation >1.5 mg/dL (P<0.05) presented higher risk. Individual recipient factors with 4 to 8 points had a lower risk of death (2.29 [CI 1.82-2.87; P<0.0001]) than those with scores >8 points (4.02 [CI 2.22-7.26; P<0.0001]).
A novel prognostic-based scoring system using donor and recipient characteristics was proposed and clinically validated. Two-factor scoring indicated the superiority of the predictability outcome and improved prediction of higher mortality.

Keywords: Graft Survival; Liver Transplantation; Survival Analysis

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358