Aplicação do escore balance of risk no transplante hepático

• Autor(a) principal: Alves, Jefferson Andre da Silva [UNIFESP]
• Data de Publicação: 2017
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• dARK ID: ark:/48912/001300000bwzk
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=5439306; http://repositorio.unifesp.br/handle/11600/50353
• topic: Liver transplantation; Balance Of Risk Score; Survival; Meld; Transplante hepático; Sobrevivência; Meld

Introduction: Balance of Risk Score (BARS), proposed by the Swiss HPB and Transplant Center, University Hospital Zurich, Switzerland, was designed to preemptively determine hepatic transplant survival . Objective: To evaluate a BARS ability to predict survival at 90 days, 1 year, 3 years and 5 years after LTx. Patients and Methods: Retrospective and observational study were performed in 866 liver transplants, in the Transplantation Program of the Hospital Israelita Albert Einstein, performed in adults (> 18 years), in the period from 01/01/2010 to 12/31/2015. Monitoring losses, splits, living donors transplants and transplants combined with other organs were excluded. BARS were calculated for each transplant performed using the variables MELD clinician, recipient age, retransplantation, need for life support, donor age and cold ischemia time (http://www.assessurgery.com/bar). Survival estimates were accompanied by 95% confidence intervals and the association between the variables of interest and the overall survival of the patients was assessed by Cox proportional hazards models. To assess a BARS 'ability to predict survival to 90 days, use ROC curves and present an estimated area under the curve (AUC), with 95% confidence intervals and p-values for the area equality test at 0.5. Result:. The AUC obtained for the 90-day period was 0.725, with a 95% CI of 0.670 to 0.781 and with a p-value of <0.001 for the equality test at 0.5. In the stratified analysis, score 18 presented the best sensitivity, considering a minimum specificity of 90%. The BARS> 18 presented survival drop from 89.7% to 60.4% in the ideal 90 days; 83.3% to 56.2% in one year; from 75.7% to 49.5% in three years and from 72.2% to 43.4% in five years. Conclusion: BARS has been shown to be reproducible and can be used as a tool to estimate survival in LTx. The achievement of LTx in patients with BARS> 18 significantly predicts a lower survival of the patient. We validate the method in Brazil.