A nomogram based on these variables was internally and externally validated and showed good performance (area under the receiver operating characteristic curve = 70.8 and 66.0%, respectively). The independent predictors of graft loss were recipient's Child score, ABO blood type incompatibility, donor serum total bilirubin over 17.1 μmol/L, and cold CIT. The 3-year graft survival rates (GSRs) in the training and validation cohorts were 64.2 and 59.3%, respectively. Donor age, recipient's MELD score, Child score, and CIT were independent predictors of ICU stay. The incidence of ICU stay over 10 days was 64.7% (503/778). Donor graft macrovesicular steatosis, graft-to-recipient weight ratio (GRWR), warm ischemia time (WIT), cold ischemia time (CIT), and ABO blood incompatibility, together with donor serum albumins, were independent predictors of EAD. Results: After applying the exclusion criteria, 778 patients were enrolled. A prediction model of graft loss was developed, and discrimination and calibration were measured. Corresponding independent risk factors were analyzed using stepwise multivariable regression analysis. Early allograft dysfunction (EAD), length of intensive care unit (ICU) stay, and graft loss were recorded. Method: Data of patients with MELD score >30 who underwent LT at three transplantation institutes between 20 were retrospectively reviewed. Predictive models aimed at avoiding donor risk factors in high-MELD score recipients are urgently required to obtain satisfactory outcomes. Therefore, balanced allocation of donor grafts is indispensable to avoid random combinations of donor and recipient risk factors, which often lead to graft or recipient loss. 7Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Chinaīackground: A high model of end-stage liver disease (MELD) score (>30) adversely affects outcomes even if patients receive prompt liver transplantation (LT).6Institute of Organ Transplantation, Zhejiang University, Hangzhou, China.5Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou, China.4National Center for Healthcare Quality Management in Liver Transplant, Hangzhou, China.3Organ Transplantation Center, The Affiliated Hospital of Qingdao University, Qingdao, China.2National Health Commission Key Laboratory of Combined Multi-Organ Transplantation, Hangzhou, China.1Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.Mengfan Yang 1,2 †, Abdul Rehman Khan 1,2 †, Di Lu 1,2, Xuyong Wei 1,2, Wenzhi Shu 1,2, Chuanshen Xu 3, Binhua Pan 1,2, Zhisheng Zhou 4, Rui Wang 1,2, Qiang Wei 1,2, Beini Cen 1,2, Jinzhen Cai 3 *, Shusen Zheng 5 * and Xiao Xu 1,4,6,7 *
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