Validation of the Balance of Risk as a Predictor of Liver Transplant Survival in a Spanish Population

Abstract

Background: The Balance of Risk (BAR) score is a simple test that combines donor and recipient variables to predict liver transplant success. It has been validated in different publications, with cut-off points of between 15 and 18 points proposed depending on the region. The aim of this study is to test the validity of the BAR score and to find the optimal cut-off point for our population.

Materials and methods: A retrospective cohort of 164 liver transplant patients was selected between January 2012 and July 2019. All were older than 18 years and were treated in a Spanish tertiary-level hospital.

Results: The receiver operating characteristic curve between BAR and 5-year survival yields a result of 0.622 (P = .046), placing the cut-off point at ≥7 (sensitivity 61.5%, specificity 61.6%). Patients with a BAR score <7 and a BAR score ≥7 have an estimated 5-year survival of 53.91 vs 47.51 months, respectively (log rank = .032). The only 2 variables associated with increased survival were a BAR score of <7 (hazard ratio = 2.566; P < .001) and a body mass index <30 (hazard ratio = 6.667; P < .001).

Conclusions: A low BAR score correlates well with liver transplant survival at 5 years. The BAR is a simple tool that should be used for donor-recipient matching. Due to the characteristics, resources, and population in our environment, a BAR score of 7 would be the optimum cut-off point for a liver transplant.