Accuracy of the BAR score in the prediction of survival after liver transplantation.

INTRODUCTION AND AIM The Balance of Risk (BAR) Score, a simple scoring system that combines six independent donor and recipient variables to predict outcome after liver transplantation (LT), was validated in a large U.S./European cohort of patients. This study aims to assess the performance of the BAR score to predict survival after liver transplantation and determine the factors associated with short and long-term survival in Latin-American patients. MATERIAL AND METHODS A retrospective cohort study was performed in 194 patients [112 (55.4%) males; mean age 52±14 years] who underwent 202 LT during the period 2003-2015. Demographic, clinical, pathological and surgical variables, as well as mortality and survival rates, were analyzed. The BAR score was investigated through a receiver operating characteristics (ROC) curve with the calculation of the area under the curve (AUC) to evaluate the predictive score power for 3-month, 1 and 5-year mortality in a matched donor-recipient cohort. Youden index was calculated to identify optimal cutoff points. RESULTS The AUC of BAR score in predicting 3-month, 1-year and 5-year mortality were 0.755 (CI95% 0.689-0.812), 0.702 (CI95% 0.634-0.764) and 0.610 (CI95% 0.539-0.678) respectively. The best cut-off point was a BAR score ≥15 points. In the multivariate analysis BAR score <15 was associated with higher survival rates at 3 months and 1 and 5-years. CONCLUSIONS BAR score <15 points is an independent predictor of better short and long-term survival in Latin-American patients undergoing LT. The BAR scoring system has an adequate diagnostic capacity allowing to predict 3 and 12-month mortality.

[1]  B. Müllhaupt,et al.  Risk Assessment in High‐ and Low‐MELD Liver Transplantation , 2017, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[2]  C. Lo Use of BAR score as predictor of short and long-term survival of liver transplantation patients , 2014, Hepatology International.

[3]  J. Bragg-Gresham,et al.  Characteristics Associated with Liver Graft Failure: The Concept of a Donor Risk Index , 2006, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[4]  N. Alkhouri,et al.  Survival outcomes scores (SOFT, BAR, and Pedi‐SOFT) are accurate in predicting post‐liver transplant survival in adolescents , 2016, Pediatric Transplantation.

[5]  M. Manns,et al.  Multicentric evaluation of model for end‐stage liver disease‐based allocation and survival after liver transplantation in Germany – limitations of the ‘sickest first’‐concept , 2011, Transplant international : official journal of the European Society for Organ Transplantation.

[6]  J. Emond,et al.  Model for end‐stage liver disease and Child‐Turcotte‐Pugh score as predictors of pretransplantation disease severity, posttransplantation outcome, and resource utilization in United Network for Organ Sharing status 2A patients , 2002, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[7]  R. Fox When to consider liver transplant during the management of chronic liver disease. , 2014, The Medical clinics of North America.

[8]  F. Lehner,et al.  The Donor-Risk-Index, ECD-Score and D-MELD-Score all fail to predict short-term outcome after liver transplantation with acceptable sensitivity and specificity. , 2012, Annals of transplantation.

[9]  I. Boin,et al.  Application of the BAR score as a predictor of short- and long-term survival in liver transplantation patients , 2014, Hepatology International.

[10]  W. Chapman,et al.  Predicting outcome after liver transplantation: utility of the model for end-stage liver disease and a newly derived discrimination function1 , 2004, Transplantation.

[11]  F. Lehner,et al.  Value of the SOFA score as a predictive model for short-term survival in high-risk liver transplant recipients with a pre-transplant labMELD score ≥30 , 2012, Langenbeck's Archives of Surgery.

[12]  Alexander Gimson,et al.  Systematic review and validation of prognostic models in liver transplantation , 2005, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[13]  J. Emond,et al.  Survival Outcomes Following Liver Transplantation (SOFT) Score: A Novel Method to Predict Patient Survival Following Liver Transplantation , 2008, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[14]  R. Gruessner,et al.  The survival outcomes following liver transplantation (SOFT) score: validation with contemporaneous data and stratification of high‐risk cohorts , 2013, Clinical Transplantation.

[15]  R. Wiesner,et al.  Model for end-stage liver disease (MELD) and allocation of donor livers. , 2003, Gastroenterology.

[16]  E. Jaurrieta,et al.  Intraoperative red blood cell transfusion in liver transplantation: Influence on patient outcome, prediction of requirements, and measures to reduce them , 2003, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[17]  N. Ortega,et al.  Factors Associated with Mortality and Graft Failure in Liver Transplants: A Hierarchical Approach , 2015, PloS one.

[18]  Philipp Dutkowski,et al.  Are There Better Guidelines for Allocation in Liver Transplantation?: A Novel Score Targeting Justice and Utility in the Model for End-Stage Liver Disease Era , 2011, Annals of surgery.

[19]  H. Schrem,et al.  Value and limitations of the BAR-score for donor allocation in liver transplantation , 2014, Langenbeck's archives of surgery (Print).

[20]  R. Martino,et al.  Better Selection Criteria With Prognostic Factors for Liver Transplantation. , 2018, Transplantation Proceedings.

[21]  P. Clavien,et al.  Balancing Utility and Need by Means of Donor‐to‐Recipient Matching: A Challenging Problem , 2013, American Journal of Transplantation.

[22]  F. Lehner,et al.  Respiratory risk score for the prediction of 3‐month mortality and prolonged ventilation after liver transplantation , 2013, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[23]  H. Schrem,et al.  Prognostic limitations of the Eurotransplant-donor risk index in liver transplantation , 2013, Journal of Negative Results in BioMedicine.

[24]  J. Hanley,et al.  The meaning and use of the area under a receiver operating characteristic (ROC) curve. , 1982, Radiology.

[25]  I. Boin,et al.  Intraoperative massive transfusion decreases survival after liver transplantation. , 2008, Transplantation proceedings.