Development of organ-specific donor risk indices

Abstract

Due to the shortage of deceased donor organs, transplant centers accept organs from marginal deceased donors, including older donors. Organ-specific donor risk indices have been developed to predict graft survival using various combinations of donor and recipient characteristics. We will review the kidney donor risk index (KDRI) and liver donor risk index (LDRI) and compare and contrast their strengths, limitations, and potential uses. The Kidney Donor Risk Index has a potential role in developing new kidney allocation algorithms. The Liver Donor Risk Index allows for greater appreciation of the importance of donor factors, particularly for hepatitis C-positive recipients; as the donor risk index increases, rates of allograft and patient survival among these recipients decrease disproportionately. Use of livers with high donor risk index is associated with increased hospital costs independent of recipient risk factors, and transplanting livers with high donor risk index into patients with Model for End-Stage Liver Disease scores < 15 is associated with lower allograft survival; use of the Liver Donor Risk Index has limited this practice. Significant regional variation in donor quality, as measured by the Liver Donor Risk Index, remains in the United States. We also review other potential indices for liver transplant, including donor-recipient matching and the retransplant donor risk index. While substantial progress has been made in developing donor risk indices to objectively assess donor variables that affect transplant outcomes, continued efforts are warranted to improve these indices to enhance organ allocation policies and optimize allograft survival.

Association Between Donor Leukocyte Telomere Length and Survival After Unrelated Allogeneic Hematopoietic Cell Transplantation for Severe Aplastic Anemia

“…In solid organ transplantation, donor age is one of the main variables guiding graft selection. 27 Biological markers of graft aging including telomere length or POT1 (protection of telomeres 1) gene expression have been associated with recipient’s outcomes after both liver 28 and kidney transplantation. 29,30 …”

Systematic Review and Meta-Analysis of Tacrolimus versus Ciclosporin as Primary Immunosuppression After Liver Transplant

“…Changes to the formulations of primary immunosuppressive therapies have been accompanied by more widespread use of induction therapies in addition to improvements in waiting list prioritization, donor-recipient matching, and concomitant immunosuppressive medications [6–9]. For instance, the use of induction antibody preparations, while still not universal in liver transplant recipients, has been steadily increasing from 13.3% in 1999 to 26.7% in 2008, a change that has been ascribed to attempts to reduce CNI-induced nephrotoxicity immediately after transplantation [7].…”

“…MMF has been the most prevalent adjunct therapy for more than 10 years. Waiting list prioritization has improved greatly as a result of the introduction and widespread use of the model for end-stage liver disease (MELD) score and the development of risk indices such as the liver donor risk index (LDRI) [8,9]. Finally, mechanistic target of rapamycin (mTOR) inhibitors such as sirolimus and everolimus have been introduced and approved for use in liver transplant recipients, although sirolimus in particular has had a challenging relationship with regulators, with the Food and Drug Administration (FDA) issuing two black box warnings for reported instances of hepatic artery thrombosis in de novo patients and increased mortality after conversion from CNIs before the data had undergone close scrutiny [11].…”

Simultaneous Liver-Kidney Transplantation in Liver Transplant Candidates With Renal Dysfunction: Importance of Creatinine Levels, Dialysis, and Organ Quality in Survival

“…11, 12 Standardized measures for assessing donor quality (liver donor risk index [L-DRI]) and recipient’s pre-transplant mortality risk (MELD score) has helped optimize transplant survival, which is essantial given the scarce organ supply. 13 However, few studies have evaluated the impact of organ quality on mortality especially among high-risk donors (LDRI> 1.5) for patients seeking SLK allocation. 14, 15 …”