Reply to letter: "The balance of risk score for allocation in liver transplantation".

To the Editor: W ith their balance of risk (BAR) score, Dutkowski et al1 present a new, simple tool both to assess the risk of recipient death after orthotopic liver transplantation (OLT) and to guide graft acceptance and allocation. The BAR score combines donor and recipient age, the length of cold ischemic time, the need for life support, and the model for endstage liver disease (MELD) score, and was developed using United Network for Organ Sharing data from adult recipients of single, whole organ, brain-dead donor liver grafts. On the basis of their analyses, the authors found a cutoff BAR score of 18 to best discriminate overall mortality at 5 years after liver transplantation. Importantly, they found that patients with laboratory MELD (LabMELD) score of 30 or more were ranked below this threshold. The BAR score was found to be superior to other predictive scores, amongst others. LabMELD. However, validation is needed in other European liver transplant centers. We therefore analyzed 3-month, 1-year, and 5-year recipient survival after OLT performed at our institution between 2000 and 2010. Living donor, partial, and combined liver transplants were excluded. Kaplan-Meier curves were constructed with log-rank tests to compare recipient survival in recipients with a LabMELD score of 6 to 29 versus a LabMELD score of 30 or more and a BAR score of 0 to 18 versus a BAR score of more than 18. Furthermore, we determined the predictive accuracy of BAR and LabMELD scores on 3-month, 1-year, and 5-year recipient survival by constructing re-