title: The Donor-Risk-Index, ECD-Score and D-MELD-Score all fail to predict short-term outcome after liver transplantation with acceptable sensitivity and specificity.
abstract: BACKGROUND
  Expansion of the donor pool by the use of grafts with extended donor criteria reduces waiting list mortality with an increased risk for graft and patient survival after liver transplantation. This study investigates the ability of the Donor-Risk-Index (DRI), the Extended-Criteria-Donor-Score (ECD-score) and the D-MELD-score to predict early outcome after liver transplantation.
  
  
  METHODS
  291 consecutive adult liver transplants (01.01.2007-31.12.2010) were analysed in a single centre study with ongoing data collection. Primary study endpoints were 30-day mortality, 3-month mortality, 3-month patient and graft survival and the necessity of acute retransplantation within 30 days. For the primary study endpoints ROC-curve analysis was performed to calculate the sensitivity, specificity, and overall model correctness of the Donor-Risk-Index (DRI), Extended-Criteria-Donor-Score (ECD-score) and the D-MELD-Score as predictive models. Cut-off values were selected with the best Youden index.
  
  
  RESULTS
  ROC-curve analysis showed areas under the curve (AUROCs) <0.7 for the DRI, the ECD-Score and the D-MELD-Score as models for the prediction of 30-day mortality, 3-month mortality, 3-month patient survival, 3-month graft survival as well as the necessity of acute retransplantation within 30 days after transplantation with unacceptable low levels of overall model correctness (<62%) and specificity (<56%).
  
  
  CONCLUSIONS
  The DRI, the ECD-Score and the D-MELD-Score all fail to predict short-term outcome after liver transplantation with acceptable overall model correctness in a current European transplant setting.
authors.affiliation: General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany. schrem.harald@mh-hannover.de
authors.forename: Harald
authors.initials: H
authors.lastname: Schrem
authors.forename: Benedikt
authors.initials: B
authors.lastname: Reichert
authors.forename: Nils
authors.initials: N
authors.lastname: Frühauf
authors.forename: Thomas
authors.initials: T
authors.lastname: Becker
authors.forename: Frank
authors.initials: F
authors.lastname: Lehner
authors.forename: Moritz
authors.initials: M
authors.lastname: Kleine
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Bektas
authors.forename: Lea
authors.initials: L
authors.lastname: Zachau
authors.forename: Jürgen
authors.initials: J
authors.lastname: Klempnauer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival; D006801:Humans; D017093:Liver Failure / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012086:Reoperation; D012306:Risk; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome