一个简短的模型根据供体移植物和受体的匹配情况对肝移植后的结果进行了评估。

IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Clinical and Translational Gastroenterology Pub Date : 2024-08-21 DOI:10.14309/ctg.0000000000000761
Yuancheng Li, Xingchao Liu, Chengcheng Zhang, Ran Tao, Bi Pan, Wei Liu, Di Jiang, Feng Hu, Zeliang Xu, Dehong Tan, Yanjiao Ou, Xun Li, Yuemei You, Leida Zhang
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引用次数: 0

摘要

背景:指导围手术期管理需要一个精确的预后模型。随着肝移植(LT)学科的发展,以前的模型可能变得不合适或不全面。因此,我们旨在开发一种整合供体和受体变量的新型模型,以快速评估移植结果:方法:该风险模型基于随机选择的衍生队列中的 Cox 回归,并在验证队列中得到验证。比较了按X-分层分组的围手术期数据和总生存率。采用接收者操作特征曲线和决策曲线分析来比较模型。生成的小提琴图和雨云图显示了不同分层中LT术后并发症的分布情况:共有来自两个中心的528名接受LT的患者,其中2/3属于推导队列,1/3属于验证队列。Cox回归分析显示,冷缺血时间(CIT)(P=0.012)和终末期肝病模型(MELD)(P=0.007)评分是预测生存率的因素。与对数模型比较后,CIT 和 MELD 的原始算法被定义为 CIT-MELD 指数(CMI)。CMI按X分层(1级≤1.06,1.06< 2级≤1.87,3级>1.87)进行分层。在两个队列中,CMI在计算移植结果(包括围手术期事件和并发症发生率)方面的表现均优于风险平衡评分:结论:整合移植物和受体变量的模型使预测更准确、更可用。CMI为LT的结果评估和风险因素管理提供了新的视角。
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A brief model evaluated outcomes after liver transplantation based on the matching of donor graft and recipient.

Background: A precise model for predicting outcomes is needed to guide perioperative management. With the developments of liver transplantation (LT) discipline, previous models may become inappropriate or noncomprehensive. Thus, we aimed to develop a novel model integrating variables from donors and recipients for quick assessment of transplant outcomes.

Methods: The risk model was based on Cox regression in a randomly selected derivation cohort and verified in a validation cohort. Perioperative data and overall survival were compared between stratifications grouped by X-tile. Receiver operating characteristic curve and decision curve analysis were used to compare the models. Violin and raincloud plots were generated to present post-LT complications distributed in different stratifications.

Results: Overall, 528 patients receiving LT from 2 centers were included with 2/3 in the derivation cohort and 1/3 in the validation cohort. Cox regression analysis showed that cold ischemia time (CIT) (P=0.012) and the Model for End-Stage Liver Disease (MELD) (P=0.007) score were predictors of survival. After comparison with the logarithmic models, the primitive algorithms of CIT and MELD were defined as the CIT-MELD Index (CMI). CMI was stratified by X-tile (grade 1 ≤1.06, 1.06< grade 2 ≤1.87, grade 3 >1.87). In both cohorts, CMI performed better in calculating transplant outcomes than the balance of risk score, including perioperative incidents and prevalence of complications.

Conclusions: Model integrating variables from graft and recipient made the prediction more accurate and available. CMI provided new sight in outcome evaluation and risk factor management of LT.

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来源期刊
Clinical and Translational Gastroenterology
Clinical and Translational Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
7.00
自引率
0.00%
发文量
114
审稿时长
16 weeks
期刊介绍: Clinical and Translational Gastroenterology (CTG), published on behalf of the American College of Gastroenterology (ACG), is a peer-reviewed open access online journal dedicated to innovative clinical work in the field of gastroenterology and hepatology. CTG hopes to fulfill an unmet need for clinicians and scientists by welcoming novel cohort studies, early-phase clinical trials, qualitative and quantitative epidemiologic research, hypothesis-generating research, studies of novel mechanisms and methodologies including public health interventions, and integration of approaches across organs and disciplines. CTG also welcomes hypothesis-generating small studies, methods papers, and translational research with clear applications to human physiology or disease. Colon and small bowel Endoscopy and novel diagnostics Esophagus Functional GI disorders Immunology of the GI tract Microbiology of the GI tract Inflammatory bowel disease Pancreas and biliary tract Liver Pathology Pediatrics Preventative medicine Nutrition/obesity Stomach.
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