Liver transplant prognostic models have limited use

The latest issue of Liver Transplantation demonstrates that currently available prognostic models of mortality after liver transplantation have only a limited role in clinical practice.

A model that can accurately predict post-liver transplant mortality would be useful for clinical decision making.

It would also help to provide patients with prognostic information, and would facilitate fair comparisons of surgical performance between transplant units.

Dr van der Meulen and colleagues from England carried out a systematic review of the literature.

5 models were assessed according to statistical validity, model evaluation, and practicality

Liver Transplantation

The research team assessed the quality of the studies that developed and validated prognostic models for mortality after liver transplantation.

The team also validated existing models in a large data set of patients transplanted in the United Kingdom and Ireland between 1994 and 2003.

The team identified 5 prognostic model papers and found that the quality of the development and validation of all prognostic models was suboptimal.

The team obtained this result according to an explicit assessment tool of the internal, external, and statistical validity, model evaluation, and practicality.

The researchers noted that the discriminatory ability of the identified models in the UK and Ireland data set was poor.

Due to the poor quality of the reporting, the team could not always determine the methodology used for the development of the model.

Dr van der Meulen's team concluded, “These findings demonstrate that currently available prognostic models of mortality after liver transplantation can have only a limited role in clinical practice, audit, and research.”