1Ajmera Transplant Program, University Health Network, Toronto, Ontario, Canada.
2Narayana Health, Bengaluru, India.
3Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
4Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
5Biostatistics Department, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
6Baylor University Medical Centre, Dallas, Texas, USA.
7Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
8Toronto General Hospital Research Institute, Toronto, Ontario, Canada.
Background: Non-alcoholic Steatohepatitis (NASH) cirrhosis is the second most common indication for liver transplantation (LT) in the US and often is associated with significant co-morbidities. We validated a model and risk prediction score that reflects the benefit derived from LT for NASH cirrhosis by predicting 5-year survival post-LT.
Methods: We developed a prediction score utilizing 6515 NASH deceased donor LT (DDLT) recipients from 2002 to 2019 from the Scientific Registry of Transplant Recipients (SRTR) database to identify a parsimonious set of independent predictors of survival. Coefficients of relevant recipient factors were converted to weighted points to construct a risk scoring system that was then externally validated.
Results: The final risk score includes the following independent recipient predictors and corresponding points: recipient age (5 points for age ≥70 years), functional status (3 points for total assistance), presence of TIPSS (2 points), hepatic encephalopathy (1 point), serum creatinine (5 points if >1.45 mg/dl), need for mechanical ventilation (3 points), and dialysis within 1 week prior to LT (7 points). Diabetes is a stratifying variable for baseline risk. Scores range from 0 to 20 with scores above 13 having an overall survival of <65% at 5 years post-LT. Internal and external validation indicated good predictive ability.
Conclusion: Our practically useable and validated risk score helps to identify and stratify candidates who will derive the most long-term benefit from LT for NASH cirrhosis.