Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society · 2026
VITRO score dynamics after liver transplantation predict portal-hypertensive events and post-transplant mortality.
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Dominik Nina, Dinjar Kujundzic Petra, Kristandl Felix, Balcar Lorenz, Hofer Benedikt S, Kramer Georg, Sebesta Christian, Thöne Paul, Hintersteininger Marlene, Györi Georg, Eichelter Jakob, Pinter Matthias, Mandorfer Mattias, Trauner Michael, Berlakovich Gabriela, Öllinger Robert, Reiberger Thomas
Аннотация
Portal hypertension (PH) after liver transplantation (LT) is rare but associated with complications and mortality. The VITRO score-combining von Willebrand factor antigen (vWF-Ag) divided by platelet count (PLT)-reflects PH severity in cirrhosis, yet its prognostic value after LT remains unknown. 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. 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: 1.40-2.57, p <0.001), alongside albumin (aHR 0.89, p =0.001) and post-LT MELD decrease (aHR 0.36, p =0.026). These findings remained robust in landmark sensitivity analyses from month 3 post-LT and after bootstrap-based internal validation. Post-LT VITRO score dynamics independently predict liver-related mortality and PH-related complications. Integration of ΔVITRO monitoring into post-LT care may facilitate individualized risk stratification after liver transplantation.