Validation of risk scores for allograft failure after liver transplantation in Germany: a retrospective cohort analysis

A growing number of clinical risk scores have been proposed to predict allograft failure after liver transplantation. However, validation of currently available scores in the Eurotransplant region is still lacking. We aimed to analyze all clinically relevant donor and recipient risk scores on a large German liver transplantation data set and performed a retrospective cohort analysis of liver transplantations performed at the Charité-Universitätsmedizin Berlin from January 2007 until December 2021 with organs from donation after brain death. We analyzed 9 previously published scores in 906 liver transplantations [Eurotransplant donor risk index (ET-DRI/DRI), donor age and model for end-stage liver disease (D-MELD), balance of risk (BAR), early allograft dysfunction (EAD), model for early allograft function (MEAF), liver graft assessment following transplantation (L-GrAFT7), early allograft failure simplified estimation (EASE), and a score by Rhu and colleagues). The EASE score had the best predictive value for 3-month, 6-month, and 12-month graft survival with a c-statistic of 0.8, 0.77, and 0.78, respectively. In subgroup analyses, the EASE score was suited best for male recipients with a high-MELD (>25) and an EAD organ. Scores only based on pretransplant data performed worse compared to scores including postoperative data (eg, ET-DRI vs. EAD, p<0.001 at 3-month graft survival). Out of these, the BAR score performed best with a c-statistic of 0.6. This a comprehensive comparison of the clinical utility of risk scores after liver transplantation. The EASE score sufficiently predicted 12-month graft and patient survival. Despite a relatively complex calculation, the EASE score provides significant prognostic value for patients and health care professionals in the Eurotransplant region

Study setup.

A Study design of environmental enrichment. Rats were received at age 6 months and kept until 12 months of age in their respective group. B Exterior v of standard cages (left) and modified rabbit cage (right). C View of the playpen, which was available for two groups weekly. D Interior view of one of the larger cages. Images by Nathalie N. Roschke [2023].</p

Qualitative proteomics of liver tissue.

A Venn diagram of liver tissue proteins identified during proteomic analysis. Labeled per group are the distinct proteins found in each group by their UniProt identifier. B-E Gene ontology analysis of distinct proteins per group. Only the top 10 pathways are displayed and labeled according to their gene ontology term. F Heatmap of label-free quantification data of discovered proteins.</p

Laboratory parameters.

A-F Biochemical analysis of blood drawn at the end of experiment. Only alanine-aminotransferase was significantly higher in the group with standard cage & playpen.</p

Enrichment usage analysis.

A&B Number of times the running plate or running wheel added to the playpen were used by the individual enrichment group. C&D Time required to solve the provided riddle by group and over time.</p

Semiquantitative proteomics of liver tissue.

A-I Selected proteins from the label-free quantification dataset with significant or near significant differences in area intensity compared by group.</p

Baseline and laboratory data of study rats.

DHEA: dehydroepiandrosterone, ALT: alanine aminotransferase, AST: aspartate aminotransferase, AP: alkaline phosphatase, LDH: lactate dehydrogenase. (PDF)</p

Hormone analysis.

A-C Analysis of corticosterone, testosterone, dehydroepiandrosterone in hair collected at the start of intervention, 3 months, and 6 months. D-F Correlation analysis between levels of testosterone and corticosterone at the different analysis timepoints.</p

Handling analysis.

A-F Results from the handling questionnaire performed after 6 months of intervention with 10 participants (5 beginner, 5 experienced in animal care and handling). Participants weighed and handled the animals and subjectively reported their experiences. No significant behavioral changes could be seen between groups.</p

Supplementary Table 2 from Transcriptional Heterogeneity Overcomes Super-Enhancer Disrupting Drug Combinations in Multiple Myeloma

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