Development and validation of a novel prognostic model to predict 1-year post-transplant mortality for acute-on-chronic hepatitis B liver failure: a nationwide, multicentre, cohort study

作者：Li Zhuang, Yimou Lin, Jia Yu, Jun Fang, Yujian Zheng, Taishi Fang, Meiching Ong, Andre Mu, Jiaxing Zhu, Mengchao Wang, Dong Zhao, Feiwen Deng, Qiucheng Lei, Lei‐Bo Xu, Zuozhong Yang, Qiang Sun, Wei Qu, Chenwei Xu, Zhi‐Jun Zhu, Chuanjiang Li, Hanyu Jiang, Jimin Liu, Xiaoshun He, Shusen Zheng, Zhiyong Guo, Qi Ling · 发表于：EClinicalMedicine · 年份：2025 · DOI：10.1016/j.eclinm.2025.103365 · 被引用次数：9 · 研究领域：Organ Transplantation Techniques and Outcomes、Hepatitis B Virus Studies、Liver Disease and Transplantation

Background: Liver transplantation (LT) provides a potential cure for hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). We aimed to develop and externally validate a prognostic model to predict 1-year post-LT mortality in patients with HBV-ACLF. Methods: < 0.05 were entered into the least absolute shrinkage and selection operator (Lasso) analysis for further feature selection. 10-fold cross validation was used to choose the optimal lambda (penalty for the number of features) of the Lasso model. Multivariable Cox regression was applied to construct the HALT model based on the risk factors selected by Lasso analysis. Primary outcome was survival rate at 1-year after LT. Secondary outcomes were short-term (28- and 90-day) and long-term survival after LT (3- and 5-year). Model performance was compared with eight other models (COSSH-ACLF II, COSSH-ACLF, CLIF-C ACLF, AARC, MELD, MELD-Na, SALT-M and TAM scores), using receiver operating characteristic curve and C-index values. A nomogram was developed to analyse the probability of the primary outcome in different graft-recipient combinations based on recipient factors (age, number of organ failures [OF], lactate) and graft factors (donation after circulatory death [DCD] and cold ischaemia time [CIT]). Findings: < 0.001). If the sickest patients (age >55 years, OFs ≥3 and lactate ≥2.5 mmol/L) received high-risk grafts (DCD and CIT >10 h), the estimated 1-year post-LT mortality was 85.6%. Interpretation: The HALT mod...