Año 2018 / Volumen 110 / Número 12
Original
Supervivencia del injerto tras trasplante hepático: aproximación a un nuevo índice de riesgo español

782-793

DOI: 10.17235/reed.2018.5473/2018

Juan José Araiz Burdio, María Trinidad Serrano Aulló, Agustín García Gil, Ana Pascual Bielsa, Alberto Lue, Sara Lorente Pérez, Beatriz Villanueva Anadón, Miguel Ángel Suárez Pinilla,

Resumen
Introducción: existen diversos indicadores para la valoración de la supervivencia del injerto hepático (DRI americano y ET-DRI europeo, entre otros), pero existen diferencias importantes entre los programas de trasplante de los diferentes países y podría ser que dichos indicadores no sean válidos en nuestro medio. Objetivos: el objetivo de este estudio es describir un nuevo indicador nacional de riesgo del injerto hepático a partir de los resultados del Registro Español de Trasplante Hepático (RETH) y validar el DRI y el ET-DRI. Metodología: el RETH incluye un análisis de Cox de los factores relacionados con la supervivencia del injerto. En base a sus resultados se define el indicador graft risk index (GRI). Las variables que contempla dependen del proceso de donación: edad, causa de muerte, compatibilidad sanguínea y tiempo de isquemia fría; y del receptor: edad, enfermedad de base, virus C, número de trasplante, estado UNOS y técnica quirúrgica. Se obtuvo la curva de la regresión logística y se calcularon las curvas de supervivencia del injerto por estratificación. La precisión se evaluó mediante el área ROC. Resultados: un GRI de 1 se corresponde con una probabilidad de pérdida del injerto del 23,25%; cada punto de aumento del GRI supone que la probabilidad se multiplica por 1,33. El GRI mostró la mejor discriminación por estratificación. El área ROC del DRI fue 0,54 (95% IC, 0,50-0,59) y del ET-DRI, 0,56 (95% IC, 0,51-0,61), frente al GRI 0,70 (95% IC, 0,65-0,73) (p < 0,0001). Conclusiones: el DRI y el ET-DRI no parecen útiles en nuestro medio y sería necesario disponer de un indicador propio. El GRI requiere un estudio nacional que perfile más el indicador y realice una validación más amplia.
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Bibliografía
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Desai NM, Mange KC, Crawford MD, et al. Predicting outcome after liver transplantation: utility of the Model for End-stage Liver Disease and a newly derived discrimination function. Transplantation 2004;77:99-106.
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Rana A, Hardy MA, Halazun KJ, et al. Survival Outcomes Following Liver Transplantation (SOFT) score: a novel method to predict patient survival following liver transplantation. Am J Transpl 2008;8:2537-2546.
Halldorson JB, Bakthavatsalam R, Fix O, et al. D-MELD, a simple predictor of post liver transplant mortality for optimization of donor/recipient Matching. Am J Transpl 2009;9:318-326.
Dutkowski P, MD, Oberkofler CE, Slankamenac K, et al There Better Guidelines for Allocation in Liver Transplantation?. A Novel Score Targeting Justice and Utility in the Model for End-Stage Liver Disease Era. Ann Surg 2011;254:745-753.
Braat AE, Blok JJ, Putter H, et al. The Eurotransplant Donor Risk Index in Liver Transplantation: ET-DRI. Am J Transpl 2012;12:2789-2796.
Briceño J, Cruz-Ramírez M, Prieto M, et al. Use of artificial intelligence as an innovative donor-recipient matching model for liver transplantation: Results from a multicenter Spanish study. J Hepatology 2014;61:1020-1028.
Lau L, Kankanige Y, Rubinstein B, et al. Machine-Learning algorithms predict graft failure after liver transplantation. Transplantation 2017;101:e125-e132.
Collett D, Friend PJ, Watson CJE. Factors associated with short- and long-term liver graft survival in the United Kingdom: development of a UK Donor Liver Index. Transplantation 2017;101:786-792.
Memoria de Resultados del Registro Español de Trasplante Hepático. Disponible en: http://www.sethepatico.org.
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Gonzalez FX, Rimola A, Grande L, et al. Predictive factors of early postoperative graft function in human liver transplantation. Hepatology 1994;20:565-573.
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Ayllón MD, Ciria R, Cruz-Ramírez M, et al. Validation of artificial neural networks as a methodology for donor recipient matching for liver transplantation. Liver Transpl. 2017. DOI: 10.1002/lt.24870.
Brown RS, Kumar KS, Russo MW, et al. Model for End-Stage Liver Disease and Child-TurcottePugh Score as Predictors of Pretransplantation Disease Severity, Posttransplantation Outcome, and Resource Utilization in United Network for Organ Sharing Status 2A Patients. Liver Transpl 2002;8:278-284.
Desai NM, Mange KC, Crawford MD, et al. Predicting outcome after liver transplantation: utility of the Model for End-stage Liver Disease and a newly derived discrimination function. Transplantation 2004;77:99-106.
Ioannou GN. Development and Validation of a Model Predicting Graft Survival After Liver Transplantation. Liver Tranpl 2006;12:1594-1606.
Feng S, Goodrich NP, Bragg-Gresham JL, et al. Characteristics associated with liver graft failure: the concept of a Donor Risk Index. Am J Transplant 2006;6:783-790.
Rana A, Hardy MA, Halazun KJ, et al. Survival Outcomes Following Liver Transplantation (SOFT) score: a novel method to predict patient survival following liver transplantation. Am J Transpl 2008;8:2537-2546.
Halldorson JB, Bakthavatsalam R, Fix O, et al. D-MELD, a simple predictor of post liver transplant mortality for optimization of donor/recipient Matching. Am J Transpl 2009;9:318-326.
Dutkowski P, MD, Oberkofler CE, Slankamenac K, et al There Better Guidelines for Allocation in Liver Transplantation?. A Novel Score Targeting Justice and Utility in the Model for End-Stage Liver Disease Era. Ann Surg 2011;254:745-753.
Braat AE, Blok JJ, Putter H, et al. The Eurotransplant Donor Risk Index in Liver Transplantation: ET-DRI. Am J Transpl 2012;12:2789-2796.
Briceño J, Cruz-Ramírez M, Prieto M, et al. Use of artificial intelligence as an innovative donor-recipient matching model for liver transplantation: Results from a multicenter Spanish study. J Hepatology 2014;61:1020-1028.
Lau L, Kankanige Y, Rubinstein B, et al. Machine-Learning algorithms predict graft failure after liver transplantation. Transplantation 2017;101:e125-e132.
Collett D, Friend PJ, Watson CJE. Factors associated with short- and long-term liver graft survival in the United Kingdom: development of a UK Donor Liver Index. Transplantation 2017;101:786-792.
Memoria de Resultados del Registro Español de Trasplante Hepático. Disponible en: http://www.sethepatico.org.
Winter A, Féray C, Audureau E, et al. External validation of the Donor Risk Index and the Eurotransplant Donor Risk Index on the French liver transplantation registry. Liver Int 2017;00:1-10.
Gonzalez FX, Rimola A, Grande L, et al. Predictive factors of early postoperative graft function in human liver transplantation. Hepatology 1994;20:565-573.
Sirivatanauksorn Y, Taweerutchana V, Limsrichamrern S, et al. Analysis of Donor Risk Factors Associated With Graft Outcomes in Orthotopic Liver Transplantation. Transplant Proc 2012;44:320-323.
Al-Freah MAB, McPhail MJW, Dionigi E, et al. Improving the diagnostic criteria for primary liver graft nonfunction in adults utilizing standard and transportable laboratory parameters: an outcome-based analysis. Am J Transplant 2017;17:1255-1266.
Grat M, Wronka KM, Patkowski W, et al. Effects of Donor Age and Cold Ischemia on Liver Transplantation Outcomes According to the Severity of Recipient Status. Dig Dis Sci 2016;61:626-635.
Schlegel A, Linecker M, Kron P, et al. Risk Assessment in High- and Low-MELD Liver Transplantation. Am J Transpl 2017;17:1050-1063.
Schoening W, Helbig M, Buescher N, et al. Eurotransplant donor-risk-index and recipient factors: influence on long-term outcome after liver transplantation – A large single-center experience. Clin Transplant 2016;30:508-517.
Araiz JJ, Serrano MT, Garcia-Gil FA, et al. Intention-to-treat survival analysis of Hepatitis C Virus/Human Immunodeficiency Cirus Coinfected Liver Transplant: Is it the waiting list?. Liver Transpl 2016;22:1187-1196.
Ayllón MD, Ciria R, Cruz-Ramírez M, et al. Validation of artificial neural networks as a methodology for donor recipient matching for liver transplantation. Liver Transpl. 2017. DOI: 10.1002/lt.24870.
Brown RS, Kumar KS, Russo MW, et al. Model for End-Stage Liver Disease and Child-TurcottePugh Score as Predictors of Pretransplantation Disease Severity, Posttransplantation Outcome, and Resource Utilization in United Network for Organ Sharing Status 2A Patients. Liver Transpl 2002;8:278-284.
Desai NM, Mange KC, Crawford MD, et al. Predicting outcome after liver transplantation: utility of the Model for End-stage Liver Disease and a newly derived discrimination function. Transplantation 2004;77:99-106.
Ioannou GN. Development and Validation of a Model Predicting Graft Survival After Liver Transplantation. Liver Tranpl 2006;12:1594-1606.
Feng S, Goodrich NP, Bragg-Gresham JL, et al. Characteristics associated with liver graft failure: the concept of a Donor Risk Index. Am J Transplant 2006;6:783-790.
Rana A, Hardy MA, Halazun KJ, et al. Survival Outcomes Following Liver Transplantation (SOFT) score: a novel method to predict patient survival following liver transplantation. Am J Transpl 2008;8:2537-2546.
Halldorson JB, Bakthavatsalam R, Fix O, et al. D-MELD, a simple predictor of post liver transplant mortality for optimization of donor/recipient Matching. Am J Transpl 2009;9:318-326.
Dutkowski P, MD, Oberkofler CE, Slankamenac K, et al There Better Guidelines for Allocation in Liver Transplantation?. A Novel Score Targeting Justice and Utility in the Model for End-Stage Liver Disease Era. Ann Surg 2011;254:745-753.
Braat AE, Blok JJ, Putter H, et al. The Eurotransplant Donor Risk Index in Liver Transplantation: ET-DRI. Am J Transpl 2012;12:2789-2796.
Briceño J, Cruz-Ramírez M, Prieto M, et al. Use of artificial intelligence as an innovative donor-recipient matching model for liver transplantation: Results from a multicenter Spanish study. J Hepatology 2014;61:1020-1028.
Lau L, Kankanige Y, Rubinstein B, et al. Machine-Learning algorithms predict graft failure after liver transplantation. Transplantation 2017;101:e125-e132.
Collett D, Friend PJ, Watson CJE. Factors associated with short- and long-term liver graft survival in the United Kingdom: development of a UK Donor Liver Index. Transplantation 2017;101:786-792.
Memoria de Resultados del Registro Español de Trasplante Hepático. Disponible en: http://www.sethepatico.org.
Winter A, Féray C, Audureau E, et al. External validation of the Donor Risk Index and the Eurotransplant Donor Risk Index on the French liver transplantation registry. Liver Int 2017;00:1-10.
Jadlowiec CC, Taner T. Liver transplantation: current status and challenges. World J Gastroenterol 2016;22:4438-4445.
Kulik U, Lehner F, Klempnauer J, Borlak J. Primary non-function is frequently associated with fatty liver allografts and high mortality after re-transplantation. Liver Int 2017;37:1219-1228.
Gonzalez FX, Rimola A, Grande L, et al. Predictive factors of early postoperative graft function in human liver transplantation. Hepatology 1994;20:565-573.
Sirivatanauksorn Y, Taweerutchana V, Limsrichamrern S, et al. Analysis of Donor Risk Factors Associated With Graft Outcomes in Orthotopic Liver Transplantation. Transplant Proc 2012;44:320-323.
Al-Freah MAB, McPhail MJW, Dionigi E, et al. Improving the diagnostic criteria for primary liver graft nonfunction in adults utilizing standard and transportable laboratory parameters: an outcome-based analysis. Am J Transplant 2017;17:1255-1266.
Grat M, Wronka KM, Patkowski W, et al. Effects of Donor Age and Cold Ischemia on Liver Transplantation Outcomes According to the Severity of Recipient Status. Dig Dis Sci 2016;61:626-635.
Schlegel A, Linecker M, Kron P, et al. Risk Assessment in High- and Low-MELD Liver Transplantation. Am J Transpl 2017;17:1050-1063.
Schoening W, Helbig M, Buescher N, et al. Eurotransplant donor-risk-index and recipient factors: influence on long-term outcome after liver transplantation – A large single-center experience. Clin Transplant 2016;30:508-517.
Araiz JJ, Serrano MT, Garcia-Gil FA, et al. Intention-to-treat survival analysis of Hepatitis C Virus/Human Immunodeficiency Cirus Coinfected Liver Transplant: Is it the waiting list?. Liver Transpl 2016;22:1187-1196.
Ayllón MD, Ciria R, Cruz-Ramírez M, et al. Validation of artificial neural networks as a methodology for donor recipient matching for liver transplantation. Liver Transpl. 2017. DOI: 10.1002/lt.24870.
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Araiz Burdio J, Serrano Aulló M, García Gil A, Pascual Bielsa A, Lue A, Lorente Pérez S, et all. Supervivencia del injerto tras trasplante hepático: aproximación a un nuevo índice de riesgo español . 5473/2018


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Recibido: 16/01/2018

Aceptado: 23/05/2018

Prepublicado: 03/09/2018

Publicado: 03/12/2018

Tiempo de revisión del artículo: 121 días

Tiempo de prepublicación: 230 días

Tiempo de edición del artículo: 321 días


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