Donor risk index and MELD interactions in predicting long-term graft survival: a single-centre experience.
BACKGROUND
Feng et al. described the donor risk index (DRI) in North American liver transplant recipients. We evaluated the effect of the DRI and model for end-stage liver disease (MELD) score on liver transplant recipients from a single center in the United Kingdom.


METHODS
Prospectively, collected data of all patients transplanted at our center between January 1995 and December 2005 were included in the analysis (n=1090). Outcomes evaluated included patient-censored and death-censored graft survival. Outcomes of liver transplantation from "high" and "low" DRI groups (> or =1.8 and <1.8, respectively) on patients categorized into low (<15), intermediate (15-30), and high (>30) MELD categories were analyzed.


RESULTS
MELD at transplant was the only significant predictor of patient survival. MELD at transplant and DRI more than 1.7 were associated with a poorer graft survival (P=0.03). There was a trend toward poorer graft survival in high DRI grafts transplanted in low and "intermediate" MELD categories (P=0.47 and 0.006, respectively). However, in the high MELD category, there was a similar graft survival for both high and low DRI grafts.


CONCLUSIONS
Patients with low and intermediate MELDs at transplantation may be better served by a low DRI graft, whereas patients with high MELD may not be compromised by receiving a high DRI graft.
Bonney
Glenn K
GK
Department of Hepatobiliary and Transplantation Surgery, St James' Unviersity Hospital, Leeds, United Kingdom.
Aldersley
Mark A
MA
Asthana
Sonal
S
Toogood
Giles J
GJ
Pollard
Stephen G
SG
Lodge
J Peter A
JP
Prasad
K Rajendra
KR
D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D002423:Cause of Death; D002648:Child; D005260:Female; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D044469:Racial Groups; D012189:Retrospective Studies; D018570:Risk Assessment; D014019:Tissue Donors / Q000706:statistics & numerical data*; D055815:Young Adult