The aim of this study was to produce a prognostic model to help predict posttransplant survival in patients transplanted with grade‐3 acute‐on‐chronic liver failure (ACLF‐3). Patients with ACLF‐3 who underwent liver transplantation (LT) between 2007 and 2017 in 5 transplant centers were included (n = 152). Predictors of 1‐year mortality were retrospectively screened and tested on a single center training cohort and subsequently tested on an independent multicenter cohort composed of the 4 other centers. Four independent pretransplant risk factors were associated with 1‐year mortality after transplantation in the training cohort: age ≥53 years (P = .044), pre‐LT arterial lactate level ≥4 mml/L (P = .013), mechanical ventilation with PaO₂/FiO₂ ≤ 200 mm Hg (P = .026), and pre‐LT leukocyte count ≤10 G/L (P = .004). A simplified version of the model was derived by assigning 1 point to each risk factor: the transplantation for Aclf‐3 model (TAM) score. A cut‐off at 2 points distinguished a high‐risk group (score >2) from a low‐risk group (score ≤2) with 1‐year survival of 8.3% vs 83.9% respectively (P < .001). This model was subsequently validated in the independent multicenter cohort. The TAM score can help stratify posttransplant survival and identify an optimal transplantation window for patients with ACLF‐3.

中文翻译：

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危重肝硬化患者的肝移植：基于移植前因素的分层效用。

本研究的目的是建立一个预后模型，以帮助预测 3 级慢性肝衰竭 (ACLF-3) 移植患者的移植后存活率。纳入了 2007 年至 2017 年间在 5 个移植中心接受肝移植 (LT) 的 ACLF-3 患者 (n = 152)。对 1 年死亡率的预测因子进行了回顾性筛选，并在单个中心培训队列中进行了测试，随后在由其他 4 个中心组成的独立多中心队列中进行了测试。在训练队列中，四个独立的移植前风险因素与移植后 1 年死亡率相关：年龄≥53 岁 ( P  = .044)、LT 前动脉乳酸水平 ≥4 mml/L ( P  = .013)、机械通气含 PaO ₂ /FiO ₂ ≤ 200 mm Hg ( P  = .026)，并且 LT 前白细胞计数 ≤ 10 G/L ( P  = .004)。该模型的简化版本是通过为每个风险因素分配 1 分得出的：Aclf-3 移植模型 (TAM) 评分。以 2 分作为分界点将高风险组（得分 >2）与低风险组（得分≤2）区分开来，1 年生存率分别为 8.3% 和 83.9%（P  < .001）。该模型随后在独立的多中心队列中得到验证。TAM 评分有助于对移植后生存进行分层，并为 ACLF-3 患者确定最佳移植窗口。