title: Donor Factors Including Donor Risk Index Predict Fibrosis Progression, Allograft Loss, and Patient Survival following Liver Transplantation for Hepatitis C Virus.
abstract: BACKGROUND
  The utilization of liver transplantation (LT) is limited by the availability of suitable organs. This study aimed to assess the impact of the donor risk index (DRI) and other donor characteristics on fibrosis progression, graft, and patient survival in hepatitis C virus (HCV)-infected LT recipients.
  
  
  METHODS
  HCV-infected LT recipients who had at least 2 post-LT protocol liver biopsy specimens available were included. Hazard ratio for bivariate analysis was computed using Cox proportional hazard regression analysis.
  
  
  RESULTS
  Of 312 recipients, 26.6% died over a median follow-up of 58.5 months (95% CI: 46.5-67.3). Fourteen patients underwent re-transplantation. Mean time to graft failure was 84.3 months, median follow-up: 59 months, 95% CI (48.2, 68.3). DRI >1.5 was significantly associated with patient and graft survival (P = 0.04). Of the subset of 104 individuals who underwent histological analysis, 67.3% progressed to ≥F2. On multivariate analysis, significant donor-specific predictors of fibrosis progression were: donor age >50 years and DRI >1.7.
  
  
  CONCLUSIONS
  (1) Fibrosis progression in HCV-infected LT recipients is strongly associated with donor characteristics, specifically donor age and DRI. (2) DRI, an objective measure of donor quality, appears to correlate both with rate of histological progression and overall patient/graft survival.
authors: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, United States.
authors: Arun
authors: A
authors: Jesudian
authors: MedStar Research Institute, United States.
authors: Sameer
authors: S
authors: Desale
authors: Georgetown University School of Medicine, United States.
authors: Jonathan
authors: J
authors: Julia
authors: Georgetown University School of Medicine, United States.
authors: Elizabeth
authors: E
authors: Landry
authors: Georgetown University School of Medicine, United States.
authors: Christopher
authors: C
authors: Maxwell
authors: Department of Pathology, MedStar Georgetown University Hospital, United States.
authors: Bhaskar
authors: B
authors: Kallakury
authors: Division of Gastroenterology and Hepatology, Johns Hopkins University, United States.
authors: Jacqueline
authors: J
authors: Laurin
authors: Division of Gastroenterology and Hepatology, Johns Hopkins University, United States.
authors: Kirti
authors: K
authors: Shetty
keywords: AA, African-American; CDA, corrected donor age; CI, confidence interval; CIT, cold ischemic time; DCD, donation after cardiac death; DM, diabetes mellitus; DRI, donor risk index; HBV, hepatitis B virus; HCV, hepatitis C virus; HIV, human immunodeficiency virus; HL, hyperlipidemia; HTN, hypertension; Hepatitis C; LBx, liver biopsy; LT, liver transplantation; MMF, mycophenolate mofetil; OPTN, Organ Procurement and Transplantation Network; OTTR, organ transplant tracking record; REDCap, Research Database Capture; TAC, tacrolimus; UNOS, United Network for Organ Sharing; donor risk index; liver transplantation