Donor Risk Factors in Orthotopic Liver Transplant: Analysis of the OPTN/UNOS Registry.

Kawakita S, Everly MJ.

Clinical Transplants 2013, Chapter 2

Abstract

The donor risk index (DRI) for orthotopic liver transplantation has the ability to predict graft survival; however, it also has limitations worth considering. These limitations include: 1) the fact that it was created based on data collected prior to the development of the Model for End-Stage Liver Disease (MELD) system; and, 2) there are reports that the DRI predicts survival differently in hepatitis C virus (HCV) positive recipients and HCV negative recipients. This study of the United Network for Organ Sharing registry data analyzed reputed donor factors using the post-MELD data and evaluated them further in HCV positive and HCV negative recipients with hepatic cirrhosis to develop a modified DRI (mDRI). We found that HCV negative cirrhotic recipients have generally higher tolerance against inferior qualities of donors than HCV positive cirrhotic patients. In addition, the results revealed the post-MELD prognostic factors that should be considered in the donor procurement processes. The group of "all recipients" and the subset of HCV positive cirrhotic recipients showed a similar set of donor risk factors found to significantly decrease graft survival. For these two groups and donor history of diabetes. Using the mDRI for "all recipients" the 1-year graft survival decreased by 3-4% per additional donor factor present. In HCV positive cirrhotic recipients the 1-year graft survival decreased by 2-6% per additional donor factor present. In addition we developed an mDRI for HCV negative cirrhotic recipients comprised of only two donor factors cytomegalovirus positive donor serostatus and donor age >or=65 years resulting in a 1-year graft survival of 87.7% for no factors and 83.2% for 2 donor factors. Overall our findings suggest that by having more refined thus fewer donor risk factors the newly proposed DRI could potentially expand the donor pool by broadening the donor acceptance range currently set by the conventional scoring system.