Medizinische Universität Graz - Research portal
Selected Publication:
SHR Neuro Cancer Cardio Lipid Metab Microb
Schrem, H; Platsakis, AL; Kaltenborn, A; Koch, A; Metz, C; Barthold, M; Krauth, C; Amelung, V; Braun, F; Becker, T; Klempnauer, J; Reichert, B.
Value and limitations of the BAR-score for donor allocation in liver transplantation.
Langenbecks Arch Surg. 2014; 399(8): 1011-1019.
Doi: 10.1007/s00423-014-1247-x
Web of Science
PubMed
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- Leading authors Med Uni Graz
- Schrem Harald Heinrich
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- Abstract:
- The MELD-score was shown to be able to predict 90-day mortality in most patients with end-stage liver disease prior to liver transplantation and is used as a widely accepted measure for transplantation urgency. Prognostic ability of the BAR-score to predict 90-day post-transplant mortality by detection of unfavourable pretransplant combinations of donor and recipient factors may help to better balance urgency versus utility. Two German cohorts (Hannover, n=453; Kiel, n=234) were retrospectively analyzed using ROC-curve analysis, goodness-of-model-fit tests, summary measures and risk-adjusted multivariate binary regression. Included were all consecutive liver transplants performed in adult recipients (minimum age 18 years). Excluded were all combined transplants and living-related organ donor transplants. Risk-adjusted multivariate regression revealed that the BAR-score is an independent risk factor for 90-day mortality after transplantation in both cohorts from Hannover and Kiel combined (p<0.001, OR=1.017, 95% CI:1.031-1.113). The area under the ROC-curve (AUROC) for the prediction of 90-day mortality using the BAR-score was 0.662 (95% CI 0.624-0.699, power>95%). Measures for association between observed 90-day mortality and the predicted probabilities in the combined cohort were concordant in 63.5% with low summary measures (Somers' D test 0.32, Goodman-Kruskal Gamma test 0.34 and Kendall's Tau a test 0.07). The BAR-score performed below accepted thresholds for potentially useful clinical prognostic models. Prognostic models with better predictive ability with AUROCs>0.700, concordance>70% and larger summary measures are required for the prediction of 90-day post-transplant mortality to enable donor organ allocation with reliable weighing of urgency versus utility.
- Find related publications in this database (using NLM MeSH Indexing)
- Adolescent -
- Adult -
- Aged -
- Aged, 80 and over -
- Child -
- Female -
- Female - epidemiology
- Humans -
- Liver Transplantation - mortality
- Male -
- Middle Aged -
- Prognosis -
- Retrospective Studies -
- Risk Assessment - methods
- Sensitivity and Specificity -
- Survival Analysis -
- Tissue Donors -
- Find related publications in this database (Keywords)
- Prognostic models
- Independent validation
- ROC-curve analysis
- Risk-adjusted analysis
- Liver transplantation