Comparative Prognostic Performance of Pretransplant AARC, CLIF-C ACLF, and MELD-Na Scores for 90-Day Mortality After Liver Transplantation in Patients With EASL-CLIF Acute-on-Chronic Liver Failure.

Authors

Nguyen Thai Cuong, Le Xuan Duong, Nguyen Chi Tam, Nam Van Do, Ngo Dinh Trung

Published in

Annals of transplantation. Volume 31. Pages e954888. Sep 08, 2026. Epub Sep 08, 2026.

Abstract

BACKGROUND Acute-on-chronic liver failure (ACLF) is associated with multiorgan failure and high short-term mortality. Liver transplantation (LT) can be lifesaving, but commonly used pretransplant severity scores were not developed to predict post-transplant mortality. This study compared AARC, CLIF-C ACLF, and MELD-Na for 90-day mortality after LT. MATERIAL AND METHODS This single-center observational cohort study included 78 consecutive patients aged 16 years or older with EASL-CLIF ACLF who underwent LT at the 108 Military Central Hospital between January 2022 and June 2025. All 3 scores were independently recalculated from a common pretransplant assessment. The primary outcome was 90-day all-cause mortality, and the primary score comparison was non-directional. Discrimination was assessed using AUROCs with stratified percentile-bootstrap confidence intervals and paired DeLong comparisons with Holm adjustment. Separate Firth logistic and Cox models evaluated associations per 1-standard-deviation increase. RESULTS HBV-related liver disease accounted for 62.8% of the cohort, and 89.7% underwent living-donor LT. Fourteen patients (17.9%) died within 90 days. CLIF-C ACLF had the highest numerical AUROC (0.755; 95% CI, 0.562-0.917), followed by MELD-Na (0.714; 0.550-0.854) and AARC (0.654; 0.491-0.799); no pairwise difference remained significant after Holm adjustment. A 1-standard-deviation increase in CLIF-C ACLF (11.05 points) and MELD-Na (6.17 points) was associated with higher 90-day mortality, whereas AARC was not. Sensitivity analyses produced similar findings. CONCLUSIONS CLIF-C ACLF showed the strongest numerical prognostic performance, but statistically significant superiority was not established. These scores should complement multidisciplinary transplant assessment.

PMID:
42706710
Bibliographic data and abstract were imported from PubMed on 08 Sep 2026.

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