Construction and validation of a prediction model for graft failure in pediatric liver transplant recipients based on the APRI-ALBI score: a retrospective study of 289 cases.
The APRI-ALBI-based nomogram shows promise for predicting graft failure in pediatric liver transplant recipients, with an AUC of 0.706 and significant findings in Kaplan-Meier analysis.
Where it sits
this study against the rest of the tb-500 (thymosin beta-4 fragment) corpusSummary and findings
This study aimed to develop and validate a nomogram based on the APRI-ALBI score for predicting graft failure in pediatric liver transplant recipients. A total of 289 children who underwent primary liver transplantation were analyzed. The nomogram achieved an AUC of 0.706 for graft failure prediction.
Abstract
<h4>Objective</h4>• • •.<h4>Background</h4>To develop and validate a preoperative APRI-ALBI-based nomogram for predicting graft failure (GF) after pediatric liver transplantation.<h4>Methods</h4>A single-center, retrospective cohort of 289 children who underwent primary liver transplantation for end-stage liver disease between April 2017 and September 2024 was enrolled. Forty-two recipient, donor and intra-operative variables were collected. Candidate predictors were first screened by univariate Logistic/Cox analysis, further reduced by LASSO regression with 10-fold cross-validation, and finally entered into multivariable models. A nomogram integrating APRI-ALBI and other independent risk factors was constructed. Model discrimination, calibration and clinical utility were assessed with ROC analysis, calibration plots, Hosmer-Lemeshow test, decision-curve analysis (DCA) and restricted cubic splines (RCS). Kaplan-Meier curves and time-dependent ROC were used to validate 1- and 3-year GF prediction.<h4>Results</h4>Multivariable Logistic/Cox analysis identified six independent predictors of GF: MELD score, male donor, APRI-ALBI score, donor height, operative time and intra-operative blood loss. The resulting nomogram achieved an AUC of 0.706, outperforming PELD, MELD and Child-Pugh scores, with good calibration (Hosmer-Lemeshow <i>p</i> > 0.05) and favorable net benefit on DCA. RCS revealed a dose-dependent increase in GF risk once APRI-ALBI exceeded 10. Kaplan-Meier analysis showed significantly lower GF-free survival in the high APRI-ALBI group (<i>p</i> < 0.01). Time-dependent ROC curves demonstrated excellent predictive accuracy at 30 days and 1 year (AUC 0.899-0.977).<h4>Conclusion</h4>APRI-ALBI is an independent risk factor for GF in pediatric liver transplantation. The APRI-ALBI-based nomogram offers robust discrimination, calibration and clinical utility for individual risk stratification.
Background
This paper addresses the clinical question of predicting graft failure in pediatric liver transplant recipients, a significant concern given the complexity of pediatric liver disease management. Previous studies have utilized various scoring systems, but there is a need for a more tailored approach. The APRI-ALBI score has been proposed as a potential predictor, and this study aims to validate its utility in a pediatric population.
Methods
The study employed a retrospective cohort design involving 289 children who underwent primary liver transplantation for end-stage liver disease from April 2017 to September 2024. A total of 42 recipient, donor, and intra-operative variables were collected. Candidate predictors were screened through univariate Logistic/Cox analysis, reduced by LASSO regression with 10-fold cross-validation, and entered into multivariable models to construct the nomogram.
Results
The primary endpoint was the prediction of graft failure, with the nomogram achieving an AUC of 0.706. The model demonstrated good calibration (Hosmer-Lemeshow p > 0.05) and favorable net benefit on decision-curve analysis. Kaplan-Meier analysis indicated significantly lower graft failure-free survival in the high APRI-ALBI group (p < 0.01). Time-dependent ROC analysis showed excellent predictive accuracy at 30 days and 1 year, with AUCs ranging from 0.899 to 0.977.
Interpretation
The findings suggest that the APRI-ALBI score is a significant independent risk factor for graft failure in pediatric liver transplantation. While the AUC values indicate good predictive ability, the clinical significance of these findings should be interpreted cautiously, especially given the small sample size and single-center nature of the study. The identified predictors may not encompass all relevant clinical factors, which could limit the model's applicability in broader settings.
Key findings
- AUC of 0.706 for the nomogram predicting graft failure.
- Kaplan-Meier analysis showed significantly lower graft failure-free survival in the high APRI-ALBI group (p < 0.01).
- Time-dependent ROC curves demonstrated predictive accuracy at 30 days and 1 year (AUC 0.899-0.977).
- Six independent predictors of graft failure identified: MELD score, male donor, APRI-ALBI score, donor height, operative time, and intra-operative blood loss.
Limitations
- Retrospective study design.
- Single-center analysis may limit generalizability.
- Potential confounding factors not included in the model.
- Reliance on specific scoring systems may overlook other clinical variables.