title: Eurotransplant donor-risk-index and recipient factors: influence on long-term outcome after liver transplantation - A large single-center experience.
abstract: The organ shortage has led to increased use of marginal organs. The Eurotransplant Donor-Risk-Index (ET-DRI) was established to estimate outcome after Liver Transplantation (LT). Currently, data on impact of ET-DRI on long-term outcome for different indications and recipient conditions are missing. Retrospective, single-center analysis of long-term graft survival (GS) of 1767 adult primary LTs according to indication, labMELDcategory (1: ≤18; 2: >18-25; 3: >25-35; 4: >35), and ET-DRI. Mean ET-DRI in our cohort was 1.63 (±0.43). One-, 10, and 15-yr GS was 83.5%, 63.3%, and 54.8%. Long-term GS was significantly influenced by ET-DRI. Accordingly, four ET-DRI categories were defined and analyzed with respect to underlying disease. Significant impact of these categories was observed for: Alcohol, cholestatic/autoimmune diseases (CD/AIH), and HCV, but not for HCC, HBV, cryptogenic cirrhosis, and acute liver failure. labMELD categories showed no significant influence on graft, but on patient survival. Matching ET-DRI categories with labMELD revealed significant differences in long-term GS for labMELDcategories 1, 2, and 3, but not 4. In multivariate analysis, HCV combined with ET-DRI > 2 and labMELDcategory 3 combined with ET-DRI > 2 emerged as negative predictors. To achieve excellent long-term graft survival, higher risk organs (ET-DRI > 1.4) should be used restrictively for patients with CD/AIH or HCV. Organs with ET-DRI > 2 should be avoided in patients with a labMELD of >25-35.
authors: Department of General, Visceral- and Transplantation Surgery, Charité, Berlin, Germany.|Department of General-, Visceral- and Transplantation Surgery, University Hospital of RWTH Aachen, Germany.
authors: Wenzel
authors: W
authors: Schoening
authors: Department of General, Visceral- and Transplantation Surgery, Charité, Berlin, Germany.
authors: Michael
authors: M
authors: Helbig
authors: Department of General, Visceral- and Transplantation Surgery, Charité, Berlin, Germany.
authors: Niklas
authors: N
authors: Buescher
authors: Department of General, Visceral- and Transplantation Surgery, Charité, Berlin, Germany.
authors: Andreas
authors: A
authors: Andreou
authors: Department of General, Visceral- and Transplantation Surgery, Charité, Berlin, Germany.
authors: Volker
authors: V
authors: Schmitz
authors: Department of General, Visceral- and Transplantation Surgery, Charité, Berlin, Germany.
authors: Marcus
authors: M
authors: Bahra
authors: Department of General, Visceral- and Transplantation Surgery, Charité, Berlin, Germany.
authors: Gero
authors: G
authors: Puhl
authors: Department of General, Visceral- and Transplantation Surgery, Charité, Berlin, Germany.
authors: Andreas
authors: A
authors: Pascher
authors: Department of General, Visceral- and Transplantation Surgery, Charité, Berlin, Germany.
authors: Johann
authors: J
authors: Pratschke
authors: Department of General, Visceral- and Transplantation Surgery, Charité, Berlin, Germany.
authors: Daniel
authors: D
authors: Seehofer
mesh_terms: D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology*; D006085:Graft Survival; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014019:Tissue Donors
keywords: donor evaluation; liver transplantation; long-term graft survival