Hohenreuther R, Silveira AT, Filho EMR, Garcez A, Lacerda BG, Fernandes SA, Marroni CA. Physiology and health assessment, risk balance, and model for end-stage liver disease scores: Postoperative outcome of liver transplantation. World J Transplant 2025; 15(1): 95899 [DOI: 10.5500/wjt.v15.i1.95899]
Corresponding Author of This Article
Sabrina Alves Fernandes, PhD, Postdoc, Professor, Researcher, Postgraduate Program in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Sarmento Leite 245, Porto Alegre 90050-170, Brazil. sabrinaafernandes@gmail.com
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Mar 18, 2025; 15(1): 95899 Published online Mar 18, 2025. doi: 10.5500/wjt.v15.i1.95899
Physiology and health assessment, risk balance, and model for end-stage liver disease scores: Postoperative outcome of liver transplantation
Raquel Hohenreuther, Andresa Thomé Silveira, Edison Moraes Rodrigues Filho, Anderson Garcez, Bruna Goularth Lacerda, Sabrina Alves Fernandes, Claudio Augusto Marroni
Raquel Hohenreuther, Andresa Thomé Silveira, Bruna Goularth Lacerda, Sabrina Alves Fernandes, Claudio Augusto Marroni, Postgraduate Program in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90050-170, Brazil
Edison Moraes Rodrigues Filho, Department of Intensive Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, Brazil
Anderson Garcez, Department of Public Health, University of Vale do Rio dos Sinos, Sao Leopoldo 93022-750, Brazil
Co-corresponding authors: Sabrina Alves Fernandes and Claudio Augusto Marroni.
Author contributions: Hohenreuther R contributed to the methodological development and material support, collected data, interpreted results, conducted data analysis, wrote and revised the manuscript; Silveira AT collected data and interpreted the results; Lacerda BG contributed to the methodological development and material support; Filho EMR and Garcez A conducted data analysis and interpreted the results; Fernandes SA contributed to the conception and critical review of the manuscript; Marroni CA designed the research project, collaborated in writing, and critically reviewed the manuscript. All authors have read and approved the final manuscript.
Institutional review board statement: The Research Ethics Committee approved it under the Brazil Platform, CAAE number 19687113.8.2001.5335.
Informed consent statement: The present study complies with ethical norms and guidelines, including Resolution of the National Health Council No. 466/12, which exempts the application of the Informed Consent Form, as there is no exposure of personal data.
Conflict-of-interest statement: There is no conflict of interest for any of the researchers.
Data sharing statement: No additional data is available for sharing.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sabrina Alves Fernandes, PhD, Postdoc, Professor, Researcher, Postgraduate Program in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Sarmento Leite 245, Porto Alegre 90050-170, Brazil. sabrinaafernandes@gmail.com
Received: April 21, 2024 Revised: October 4, 2024 Accepted: November 4, 2024 Published online: March 18, 2025 Processing time: 219 Days and 17.5 Hours
Abstract
BACKGROUND
Liver transplantation aims to increase the survival of patients with end-stage liver diseases and improve their quality of life. The number of organs available for transplantation is lower than the demand. To provide fair organ distribution, predictive mortality scores have been developed.
AIM
To compare the Acute Physiology and Chronic Health Evaluation IV (APACHE IV), balance of risk (BAR), and model for end-stage liver disease (MELD) scores as predictors of mortality.
METHODS
Retrospective cohort study, which included 283 adult patients in the postoperative period of deceased donor liver transplantation from 2014 to 2018.
RESULTS
The transplant recipients were mainly male, with a mean age of 58.1 years. Donors were mostly male, with a mean age of 41.6 years. The median cold ischemia time was 3.1 hours, and the median intensive care unit stay was 5 days. For APACHE IV, a mean of 59.6 was found, BAR 10.7, and MELD 24.2. The 28-day mortality rate was 9.5%, and at 90 days, it was 3.5%. The 28-day mortality prediction for APACHE IV was very good [area under the curve (AUC): 0.85, P < 0.001, 95%CI: 0.76-0.94], P < 0.001, BAR (AUC: 0.70, P < 0.001, 95%CI: 0.58–0.81), and MELD (AUC: 0.66, P < 0.006, 95%CI: 0.55-0.78), P < 0.008. At 90 days, the data for APACHE IV were very good (AUC: 0.80, P < 0.001, 95%CI: 0.71–0.90) and moderate for BAR and MELD, respectively, (AUC: 0.66, P < 0.004, 95%CI: 0.55–0.77), (AUC: 0.62, P < 0.026, 95%CI: 0.51–0.72). All showed good discrimination between deaths and survivors. As for the best value for liver transplantation, it was significant only for APACHE IV (P < 0.001).
CONCLUSION
The APACHE IV assessment score was more accurate than BAR and MELD in predicting mortality in deceased donor liver transplant recipients.
Core Tip: The organ allocation policy has been improving in recent decades, with the utilization of models and scales that reduce mortality among patients on the waiting list and enable a better assessment of post-transplant prognosis with appropriate donor-recipient matching. This article aims to compare the Acute Physiology and Chronic Health Evaluation IV, balance of risk, and model for end-stage liver disease scores as predictors of mortality.
