# Novel scoring system to predict futile liver transplantation by multiterm outcomes to optimize recipient selection: retrospective cohort study

## TL;DR

This study creates a new scoring system to identify liver transplants likely to fail, helping doctors choose better candidates.

## Contribution

A novel scoring system was developed to predict futile liver transplants using multiterm outcomes and multiple risk factors.

## Key findings

- Patients with high scores in the new system had significantly lower survival rates at 3 months, 1 year, and 3 years.
- The new scoring system outperformed previous models with an area under the ROC curve of 0.921.
- The system combines recipient and donor factors to better predict transplant futility.

## Abstract

Improvements in medical standards have allowed critically ill patients to benefit from liver transplantation, but defining futility arbitrarily according to one single-stage outcome could deprive patients of the potential benefits of transplantation. This study aimed to redefine futile liver transplantation by multiterm outcomes and develop a novel scoring system to predict futile liver transplantation.

This retrospective study in China enrolled patients who had liver transplantation from 3 centres between January 2015 and April 2021. Independent risk factors were identified by logistic regression analysis and used to establish risk prediction models. Kaplan–Meier survival curves were calculated to explore the association between futile score and overall survival.

Of 1408 patients undergoing liver transplantation, patients at persistent high risk for mortality in the short term (3 months), mid term (1 year), and long term (3 years) were defined as the truly futile liver transplantation group. Higher donor and recipient age, hepatorenal syndrome, intensive care unit stay, need for mechanical ventilator, ABO blood group incompatibility, prolonged cold ischaemia time, increased alanine aminotransferase levels, and decreased albumin levels were independent risk factors for futility, and were used to construct a futile scoring system. The scoring system had good predictive capability, with an area under the receiver operating characteristic curve of 0.921, better than that of a previously established scoring system. Survival analysis showed that the group with a high futile risk had decreased survival.

This study has redefined futile liver transplantation and established a novel futile scoring system. This can be used to optimize the allocation of medical resources, especially with regard to recipient selection for liver transplantation, and increase survival prediction for selected patients.

This study redefined patients at persistent high risk as the truly futile liver transplantation group, and constructed a futile scoring system that combined recipient and donor factors. The scoring system had good predictive ability, and can be used to optimize the allocation of medical resources, especially with regard to recipients withdrawing from liver transplantation, and ensure the survival chances of certain patients.