Factor V Serves as an Early Biomarker for Graft Loss After Liver Transplant: A Prospective Evaluation

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2025-01-27 DOI:10.1111/ctr.70086

Annabel K. Gravely, Marco P. A. W. Claasen, Tommy Ivanics, Erin Winter, Peregrina Peralta, Markus Selzner, Gonzalo Sapisochin

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Abstract

Background

Low post-operative day (POD) 1 Factor V has been retrospectively associated with graft loss after liver transplantation when stratified by a cutoff of 0.36 U/mL. We aimed to validate this prospectively.

Methods

Patients transplanted at Toronto General Hospital were recruited (May 2018–March 2021). Factor V measurements were obtained on POD1-3, 5, and 7. Graft and patient survival at 3, 6, and 12 months were primary and secondary outcomes, respectively. We identified an optimal cutoff through receiver operating characteristic (ROC) analysis and the Youden index. Kaplan–Meier method and Log-rank tests were used to assess/compare survival.

Results

One hundred and twenty-nine patients were included. One hundred and eight had Factor V >0.36 and 21 had ≤0.36 U/mL. This cutoff was predictive of 6- and 12-month graft survival and 12-month patient survival. With an optimal cutoff of 0.46 U/mL on POD1, 87 patients had Factor V >0.46 and 42 had ≤0.46 U/mL. Three-, 6-, and 12-month graft survival rates were 100%, 98.8%, and 98.8%, for patients with Factor V >0.46 U/mL, and 92.9%, 87.7%, and 87.7% for Factor V ≤0.46 U/mL. Similarly, 3-, 6-, and 12-month patient survival rates were 98.8%, 96.4%, and 95.0% for patients with Factor V >0.46 U/mL, and 92.9%, 88.0%, and 82.9% for Factor V ≤0.46 U/mL. Stratification below the novel cutoff was associated with decreased graft survival at months 3 (p = 0.012), 6 (p = 0.006), and 12 (p = 0.006), and decreased patient survival at 12 months (p = 0.022).

Conclusions

Factor V serves as an early biomarker for graft loss, with an optimal predictive cutoff of 0.46 U/mL in this prospective population. Validation of this new cutoff is necessary.

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背景：回顾性研究发现，术后第 1 天（POD）因子 V 偏低与肝移植后移植物丢失有关，其分层临界值为 0.36 U/mL。我们的目的是对其进行前瞻性验证：招募了多伦多总医院的移植患者（2018 年 5 月至 2021 年 3 月）。因子 V 的测量在 POD1-3、5 和 7 进行。3、6 和 12 个月的移植物存活率和患者存活率分别是主要和次要结果。我们通过接收者操作特征（ROC）分析和尤登指数确定了最佳截断点。采用卡普兰-梅耶法和对数秩检验来评估/比较存活率：结果：共纳入 129 名患者。其中 108 例患者的因子 V >0.36，21 例患者的因子 V ≤0.36 U/mL。这一临界值可预测 6 个月和 12 个月的移植物存活率以及 12 个月的患者存活率。POD1 的最佳临界值为 0.46 U/mL，87 例患者的因子 V >0.46 U/mL，42 例患者的因子 V ≤0.46 U/mL。因子 V >0.46 U/mL 的患者 3 个月、6 个月和 12 个月的移植物存活率分别为 100%、98.8% 和 98.8%，因子 V ≤0.46 U/mL 的患者 3 个月、6 个月和 12 个月的移植物存活率分别为 92.9%、87.7% 和 87.7%。同样，因子 V >0.46 U/mL 的患者 3 个月、6 个月和 12 个月的生存率分别为 98.8%、96.4% 和 95.0%，因子 V ≤0.46 U/mL 的患者 3 个月、6 个月和 12 个月的生存率分别为 92.9%、88.0% 和 82.9%。低于新临界值的分层与第3个月（p = 0.012）、第6个月（p = 0.006）和第12个月（p = 0.006）的移植物存活率下降以及12个月的患者存活率下降（p = 0.022）有关：结论：因子 V 是移植物丢失的早期生物标志物，在该前瞻性研究人群中，最佳预测截断值为 0.46 U/mL。有必要对这一新的临界值进行验证。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.