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Development and Validation of A Novel Prognostic Model to Predict 1-Year Post-Transplant Mortality for Acute-on-Chronic Hepatitis B Liver Failure: A Nationwide, Multicenter, Cohort Study
22 Pages Posted: 27 Mar 2025
More...Abstract
Background: Liver transplantation (LT) provides a potential cure for hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). We aimed to develop and externally validate a prognostic model to predict 1-year post-LT mortality in patients with HBV-ACLF.
Methods: 4,378 adult patients from ten LT centers who underwent primary LT between January 2015 and December 2021 were screened, and those with HBV-ACLF according to the COSSH-ACLF criteria were included. The HBV-ACLF LT (HALT) model was developed in the derivation cohort and validated in the external testing cohort.
Findings: 668 patients were included (derivation cohort, n=418; external testing cohort, n=250), with survival rates of 88.0%, 81.1%, 77.5%, 75.6% and 72.1% at 28-day, 90-day, 1-year, 3-year and 5-year post-LT, respectively. Three recipient’s factors (age, number of organ failure [OF] and arterial lactate concentration) as well as two graft’s parameters (donation after circulatory death [DCD] and cold ischemia time [CIT]) were independently associated with 1-year post-LT mortality in the derivation cohort (all p <0.05). The HALT model was established accordingly, showing better discriminative performance (C-index, 0.791) than eight current models in the external testing cohort (C-index, 0.529-0.627; all p <0.001). If the sickest patients (age >55 years, OFs ≥3 and lactate ≥2.5 mmol/L) received high-risk grafts (DCD and CIT >10 hours), the estimated 1-year post-LT mortality was 85.6%.
Interpretation: The HALT model showed superior predictive ability over eight current models and may help for LT candidate selection and optimal organ allocation. We might call a “HALT” to a very high-risk graft-recipient combination from potentially futile LT.
Keywords: hepatitis B-related acute-on-chronic liver failure, liver transplantation, post-transplant mortality, prognostic model, graft-recipient combination
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