VITRO score dynamics after liver transplantation predict portal-hypertensive events and post-transplant mortality

作者：Nina Dominik, Petra Dinjar Kujundžić, Felix Kristandl, Lorenz Balcar, Benedikt S. HOFER, Georg Kramer, Christian Sebesta, Paul Thöne, Marlene Hintersteininger, Georg Györi, Jakob Eichelter, Matthias Pinter, Mattias Mandorfer, Michael Trauner, Gabriela Berlakovich, Robert Öllinger, Thomas Reiberger · 发表于：Liver Transplantation · 年份：2026 · DOI：10.1097/lvt.0000000000000965 · 研究领域：Liver Disease and Transplantation、Organ Transplantation Techniques and Outcomes、Liver Diseases and Immunity

BACKGROUND AIMS: Portal hypertension (PH) after liver transplantation (LT) is rare but associated with complications and mortality. The VITRO score - combining von Willebrand Factor antigen (vWF) divided by platelet count (PLT) - reflects PH severity in cirrhosis, yet its prognostic value after LT remains unknown. METHODS: VITRO score dynamics and clinical outcomes were evaluated in 272 consecutive adult patients with available vWF-Ag measurements undergoing LT between 2016 and 2022 at the Medical University of Vienna. Laboratory parameters were assessed at listing, pre-LT, and at 3-6 and 12 months post-LT. Endpoints included overall mortality and a composite endpoint of PH events and/or liver-related death within 12 months post-LT. RESULTS: At listing, 89% of patients presented with clinically significant portal hypertension (CSPH), with markedly elevated vWF levels (median: 369%, IQR: 262-420) and VITRO scores (median: 3.3, IQR: 2.1-4.8). Following LT, PLT normalized in most cases, with vWF levels decreasing to 206% (IQR: 141-296) and VITRO scores improving to 1.1 (IQR: 0.9-1.5) at 3-6 months post-LT. ΔVITRO was significantly associated with both overall mortality (HR: 1.57, 95% CI: 1.28-1.93, p<0.001) and the composite endpoint of PH events/liver-related death (HR: 1.53, 95% CI: 1.24-1.88, p<0.001) within 12 months post-LT. In multivariable analysis adjusted for albumin, MELD dynamics, and age, ΔVITRO emerged as an independent predictor of mortality (aHR: 1.90, 95% CI: 1.4...