title: The corrected donor age for hepatitis C virus-infected liver transplant recipients.
abstract: Donor age has become the dominant donor factor used to predict graft failure (GF) after liver transplantation (LT) in hepatitis C virus (HCV) recipients. The purpose of this study was to develop and validate a model of corrected donor age (CDA) for HCV LT recipients that transforms the risk of other donor factors into the scale of donor age. We analyzed all first LT recipients with HCV in the United Network for Organ Sharing (UNOS) registry from January 1998 to December 2007 (development cohort, n = 14,538) and January 2008 to December 2011 (validation cohort, n = 7502) using Cox regression, excluding early GF (<90 days from LT). Accuracy in predicting 1 year GF (death or repeat LT) was assessed with the net reclassification index (NRI). In the development cohort, after controlling for pre-LT recipient factors and geotemporal trends (UNOS region, LT year), the following donor factors were independent predictors of GF, all P < 0.05: donor age (hazard ratio [HR], 1.02/year), donation after cardiac death (DCD; HR, 1.31), diabetes (HR, 1.23), height < 160 cm (HR, 1.13), aspartate aminotransferase (AST) ≥ 120 U/L (HR, 1.10), female (HR, 0.94), cold ischemia time (CIT; HR, 1.02/hour), and non-African American (non-AA) donor-African American (AA) recipient (HR, 1.65). Transforming these risk factors into the donor age scale yielded the following: DCD = +16 years; diabetes = +12 years; height < 160 cm = +7 years; AST ≥ 120 U/L = +5 years; female = -4 years; and CIT = +1 year/hour > 8 hours and -1 year/hour < 8 hours. There was a large effect of donor-recipient race combinations: +29 years for non-AA donor and an AA recipient but only +5 years for an AA donor and an AA recipient, and -2 years for an AA donor and a non-AA recipient. In a validation cohort, CDA better classified risk of 1-year GF versus actual age (NRI, 4.9%; P = 0.009) and versus the donor risk index (9.0%, P < 0.001). The CDA, compared to actual donor age, provides an intuitive and superior estimation of graft quality for HCV-positive LT recipients because it incorporates additional factors that impact LT GF rates.
authors.affiliation: Hepatopatías Infecciosas, Hospital Francisco J. Muñiz, Buenos Aires, Argentina.
authors.forename: Melisa
authors.initials: M
authors.lastname: Dirchwolf
authors.affiliation: University of California San Francisco, Department of Surgery, San Francisco, CA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Dodge
authors.affiliation: University of Colorado, Departments of Pediatrics and Biostatistics and Informatics, Anschutz Medical Campus, Aurora, CO.
authors.forename: Jane
authors.initials: J
authors.lastname: Gralla
authors.affiliation: University of Colorado, Division of Gastroenterology and Hepatology, Anschutz Medical Campus, Aurora, CO.
authors.forename: Kiran M
authors.initials: KM
authors.lastname: Bambha
authors.affiliation: University of Colorado, Department of Surgery, Anschutz Medical Campus, Aurora, CO.
authors.forename: Trevor
authors.initials: T
authors.lastname: Nydam
authors.affiliation: University of Colorado, Division of Gastroenterology and Hepatology, Anschutz Medical Campus, Aurora, CO.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Hung
authors.affiliation: University of Colorado, Division of Gastroenterology and Hepatology, Anschutz Medical Campus, Aurora, CO.
authors.forename: Hugo R
authors.initials: HR
authors.lastname: Rosen
authors.affiliation: University of California San Francisco, Department of Surgery, San Francisco, CA.
authors.forename: Sandy
authors.initials: S
authors.lastname: Feng
authors.affiliation: University of California San Francisco, Division of Gastroenterology and Hepatology, San Francisco, CA.
authors.forename: Norah A
authors.initials: NA
authors.lastname: Terrault
authors.affiliation: University of Colorado, Division of Gastroenterology and Hepatology, Anschutz Medical Campus, Aurora, CO.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Biggins
mesh_terms: D000328:Adult; D000367:Age Factors; D003661:Decision Support Techniques; D046148:Donor Selection; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery* / Q000821:virology; D005260:Female; D006085:Graft Survival; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D016013:Likelihood Functions; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D014481:United States