Pediatric discard risk index for predicting pediatric liver allograft discard

Abstract

There is a shortage of pediatric liver allografts available for transplantation, and at the same time, there are over 100 allografts discarded each year. In 2006, the DRI was developed using donor factors and cold ischemia time to predict liver graft failure. 1 However, the DRI has little clinical relevance due to its poor predictive capacity. [2][3][4][5] Because of this poor predictive capacity, marginal allografts are accepted based on the surgeon's subjective assessment of the donor allograft at the time of donation. This assessment, coupled with liver biopsy results, has often resulted in allografts being accepted despite adverse laboratory values and demographic characteristics. 5,6 Similarly, allografts that might have otherwise been successfully transplanted were likely discarded.

Risk Index Predicts Pediatric Heart Allograft Non‐Utilization

“…Additionally, a similar analysis exists for pediatric liver transplant 14 . These studies found similar risk factors such as donor age, liver enzymes, LVEF, and donor HBV or HCV antibody status, among other factors 14 . Our analysis showed that high LVEF increases the likelihood of non‐utilization.…”

“…14 These studies found similar risk factors such as donor age, liver enzymes, LVEF, and donor HBV or HCV antibody status, among other factors. 14 Our analysis showed that high LVEF increases the likelihood of non-utilization. This finding is unique and seemingly paradoxical that cannot easily be explained by current literature or clinical understanding.…”

“…analyzed a European cohort of 4110, finding risk factors for non‐utilization such as donor age and chronic medical conditions 1,15 . Additionally, a similar analysis exists for pediatric liver transplant 14 . These studies found similar risk factors such as donor age, liver enzymes, LVEF, and donor HBV or HCV antibody status, among other factors 14 .…”

“…However, while studies such as Khan et al 's identified risk factors associated with allograft utilization, there has yet to be a study that comprehensively assesses risk factors for pediatric heart allograft non‐utilization and quantifies this risk 13 . This study aims to create a pediatric non‐utilization risk index (phDSRI) that uses donor factors to quantify and predict the risk of non‐utilization for a pediatric donor heart allograft at time of initial offering 1,14 . We quantify the risk by creating a pediatric non‐utilization risk index (phDSRI) that uses donor factors to predict heart allograft non‐utilization.…”

“…13 This study aims to create a pediatric non-utilization risk index (phDSRI) that uses donor factors to quantify and predict the risk of non-utilization for a pediatric donor heart allograft at time of initial offering. 1,14 We quantify the risk by creating a pediatric non-utilization risk index (phDSRI) that uses donor factors to predict heart allograft non-utilization. By stratifying allografts based on their risk for non-utilization, a phDSRI may facilitate more effective distribution of marginal allografts to more aggressive centers.…”