title: Factors Associated With Short- and Long-term Liver Graft Survival in the United Kingdom: Development of a UK Donor Liver Index.
abstract: BACKGROUND
  A measure of donor liver quality, the donor liver index, was developed and validated for the UK population of transplant recipients. Unlike previously proposed measures, this index is only based on variables that are available at the point of retrieval, and so does not include cold ischemic time.
  
  
  METHODS
  Indices of liver quality were based on data from the UK Transplant Registry on all 7929 liver transplants between January 2000 and December 2014.
  
  
  RESULTS
  The donor liver index (DLI) was based on factors shown to affect graft survival, which included donor age, sex, height, type (donor after brain death or circulatory death), bilirubin, smoking history, and whether the liver was split. A separate index (DLI1) looking at 1-year survival showed donor cardiac disease, black ethnicity, and steatosis to be additional risk factors. A strong association was found between DLI and whether or not a surgeon accepts an offered liver for transplant, with a marked fall in acceptance rates for livers with an index greater than 1.31. Since 2000, there has been a notable reduction in the quality of livers transplanted, coupled with variation between the 7 UK liver transplant centers in risk appetite.
  
  
  CONCLUSIONS
  The DLI is an index of liver quality which enables analysis of the changing trends in liver quality and center behavior. DLI1 enables identification of factors affecting shorter-term survival, and perhaps identifies a cohort of livers that may benefit from novel preservation technologies.
authors.affiliation: 1 Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom. 2 Oxford Transplant Centre, Churchill Hospital, Oxford, United Kingdom. 3 University of Cambridge Department of Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom. 4 The National Institute for Health Research Blood and Transplant Research Unit (NIHR BTRU) in Organ Donation and Transplantation at the University of Cambridge, Cambridge, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Collett
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Friend
authors.forename: Christopher J E
authors.initials: CJ
authors.lastname: Watson
mesh_terms: D000328:Adult; D000367:Age Factors; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D003661:Decision Support Techniques; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012042:Registries; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D015415:Biomarkers; D001663:Bilirubin