title: 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.
authors: Departments of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, the Netherlands.
authors: Joris J
authors: JJ
authors: Blok
authors: Andries E
authors: AE
authors: Braat
authors: Rene
authors: R
authors: Adam
authors: Andrew K
authors: AK
authors: Burroughs
authors: Hein
authors: H
authors: Putter
authors: Nigel G
authors: NG
authors: Kooreman
authors: Axel O
authors: AO
authors: Rahmel
authors: Robert J
authors: RJ
authors: Porte
authors: Xavier
authors: X
authors: Rogiers
authors: Jan
authors: J
authors: Ringers
mesh_terms: D000328:Adult; D000368:Aged; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality / Q000592:standards*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000592:standards*; D016896:Treatment Outcome