Validation of the donor risk index in orthotopic liver transplantation within the Eurotransplant region

Abstract

In Eurotransplant, more than 50% of liver allografts come from extended criteria donors (ECDs). However, not every ECD is the same. The limits of their use are being explored. A continuous scoring system for analyzing donor risk has been developed within the Organ Procurement and Transplantation Network (OPTN), the Donor Risk Index (DRI). The objective of this study was the validation of this donor risk index (DRI) in Eurotransplant. The study was a database analysis of all 5939 liver transplants involving deceased donors and adult recipients from January 1, 2003 to December 31, 2007 in Eurotransplant. Data were analyzed with Kaplan‐Meier and Cox regression models. Follow‐up data were available for 5723 patients with a median follow up of 2.5 years. The mean DRI was remarkably higher in the Eurotransplant region versus OPTN (1.71 versus 1.45), and this indicated different donor populations. Nevertheless, we were able to validate the DRI for the Eurotransplant region. Kaplan‐Meier curves per DRI category showed a significant correlation between the DRI and outcomes (P < 0.001). A multivariate analysis demonstrated that the DRI was the most significant factor influencing outcomes (P < 0.001). Among all donor, transplant, and recipient variables, the DRI was the strongest predictor of outcomes. Liver Transpl 18:113–120, 2012. © 2011 AASLD.

A multicentre randomised controlled trial to compare the efficacy of ex-vivo normothermic machine perfusion with static cold storage in human liver transplantation

“…Several donor parameters have been identified as relative risk factors for poor outcome, including age; steatosis; DCD donation; split livers; prolonged cold ischaemia time (>12 hours). These were all developed using North American data and formulated into an algorithm known as the 'Donor Risk Index' (DRI) [3], and later validated using European data [4].…”

MELD score measured day 10 after orthotopic liver transplantation predicts death and re-transplantation within the first year

“…To assess donor quality we used the donor risk index modified to the Eurotransplant region for which high scores are associated with inferior outcome for the recipient, but with a low predictive ability (20,22,29,30). Data were retrospectively collected, but with a low frequency of missing data, for example biochemistry data were only missing for 10 patients (3%) at day 10 after transplantation.…”

Advancing Transplantation

“…5 For example, as the age of the donor and the risk index increase, there is a stepwise decrease in liver survival. 5,6 The key question is to understand the basis of this association and the phenotype and mechanism of the failures. Associations with donor age are complicated by the inherent bias in organ allocation.…”