Liver transplantation is often the only lifesaving option for acute liver failure (ALF); however, the predictors of short-term mortality (death within one year) after living donor liver transplantation (LDLT) for ALF have yet to be defined. We retrospectively collected patients ≥18 years old who underwent LDLT for ALF between 2010 and 2020 at 35 centers in Asia. Univariate and multivariate logistic regression analyses were conducted to identify the clinical variables related to short-term mortality and establish a novel scoring system. The Kaplan-Meier method was performed to explore the association between the score and overall survival. Of the 339 recipients, 46 (13.6%) died within 1 year after LDLT. Multivariate analyses revealed 4 independent risk factors for death: use of vasopressors or mechanical ventilation, the higher model for end-stage liver disease score, and a lower graft-to-recipient weight ratio. The internally validated c-statistic of the short-term mortality after transplant (SMT) score derived from these 4 variables was 0.80 (95% confidence interval: 0.74-0.87). The SMT score successfully stratified recipients into low-, intermediate-, and high-risk groups with 1-year overall survival rates of 96%, 80%, and 50%, respectively. In conclusion, our novel SMT score based on 4 predictors will guide ALF recipient and living donor selection.

中文翻译：

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一种预测急性肝衰竭活体肝移植后短期死亡率的新型评分系统


肝移植通常是急性肝衰竭（ALF）的唯一挽救生命的选择；然而，ALF 活体肝移植 (LDLT) 后短期死亡率（一年内死亡）的预测因素尚未确定。我们回顾性收集了 2010 年至 2020 年间在亚洲 35 个中心因 ALF 接受 LDLT 的 18 岁以上患者。进行单变量和多变量逻辑回归分析，以确定与短期死亡率相关的临床变量并建立新的评分系统。采用 Kaplan-Meier 方法探索评分与总生存率之间的关联。在 339 名接受者中，46 名（13.6%）在 LDLT 后 1 年内死亡。多变量分析揭示了 4 个独立的死亡危险因素：使用升压药或机械通气、终末期肝病评分较高的模型以及较低的移植物与受体的体重比。由这 4 个变量得出的移植后短期死亡率 (SMT) 评分的内部验证 c 统计值为 0.80（95% 置信区间：0.74-0.87）。 SMT 评分成功地将受者分为低风险组、中风险组和高风险组，1 年总体生存率分别为 96%、80% 和 50%。总之，我们基于 4 个预测因子的新型 SMT 评分将指导 ALF 接受者和活体捐赠者的选择。