The development and validation of a classification system for biliary complications following orthotopic liver transplantation
Bibliographic record
Abstract
Introduction: The estimated incidence of biliary complications after OLT ranges from 10-40% but the absence of a standardized classification system prevents accurate documentation. We propose a structured classification for biliary complications following choledocho-choledochal anastomosis (CCA) at non living-related OLT. The classification is based on 3 major components and anatomic location: strictures (intrahepatic, common hepatic or anastomotic), leaks (anastomotic, non-anastomotic) and filling defects. The initial steps in proposing this classification are to test its reliability and validity. Methods: The study population consisted of OLT recipients from the McGill University Health Centre who underwent transplantation between 2004-2011. Reliability was determined using formal reliability testing including inter-rater reliability and test-retest reliability. The classification scheme was validated by analysis of the relationship between classification elements and important clinical outcomes (including diagnostic studies, need for revisional surgery, repeat transplantation, number of post-transplant hospital admissions, the total number of hospital admission days and graft and patient survival). Results: A total of 184 patients, including 76 patients with biliary complications, were included. Both inter-rater reliability and test-retest reliability showed high levels of agreement with kappa statistic greater than 0.8 for all classification elements. The proposed classification components showed a strong relationship with the selected clinical outcomes. Poorer clinical outcomes were observed with strictures when compared to leaks or filling defects. Within the differing types of strictures, increasing severity of the complications was demonstrated with higher level biliary lesions, further supporting validity of our classification method. The relationship between stricture components of the classification and days of hospital admission exemplifies the validation method; adjusted rate ratio (95% confidence interval) for days of hospital admission for anastomotic, common duct and bilateral intra-hepatic strictures was 2.01 (1.84- 2.18), 3.80 (3.42-4.21) and 7.05 (6.46- 7.70) respectively. Conclusions: The proposed classification of biliary complications shows excellent reliability and good construct validity. The significant difference in clinical outcomes between different classification components demonstrates the appropriateness of the chosen components. The classification components reflect the relative severity of the different complications, further supporting validity. Given small numbers in this preliminary study, larger numbers are needed to further validate the classification
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.038 | 0.066 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.005 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".