The combination of ET-DRI and recipient risk factors is predictive of graft failure after liver transplantation within the Eurotransplant region
J.J. Blok, J. Ringers, H. Putter, A.O. Rahmel, X. Rogiers, A.E. Braat
Moderator(s): J. Ringers en T.P.J. Bezema
Location(s): Kleine Foyer
Category:
Introduction The Eurotransplant Donor Risk Index (ET-DRI) is a donor risk model predictive of graft failure after liver transplantation. Obviously, a combination of donor and recipient risk would be more complete in predicting outcome. Currently such a model does not exist for the Eurotransplant region.
OBJECTIVE Investigation of the predictive value of the combination of donor risk (ET-DRI) and recipient risk (RRI) as a predictive model of outcome after liver transplantation. Methods All liver transplants within the Eurotransplant region in adult (≥18) recipients performed from 1.1.2008 till 31.12.2010 were retrospectively analysed. A simplified recipient risk index (RRI) was created using all available recipient factors (age, sex, cause of end-stage liver disease, MELD, urgency status and retransplant status). Results A total of 4466 liver transplants were performed. Median donor age was 53 years and most frequent cause of death (COD) was by cerebrovascular accident (62%). Median cold ischemia time (CIT) was 9 hours and 25% of all transplants were performed with a rescue organ. Median DRI and ET-DRI were 1.78 and 1.82 respectively. Median recipient age was 55 years and most frequent cause of end-stage liver disease (ESLD) was alcoholic cirrhosis (24%), followed by patients with a malignant liver disease (21%). Patients were mainly transplanted according to their laboratory MELD score (72%). Median lab-MELD was 23. The ET-DRI was highly significant in the Cox-regression analysis, correcting for recipient factors (Log-Rank test p<0.001; c-index 0.54). A second analysis of the combination of the ET-DRI with MELD gave a strong correlation with outcome (Log-Rank p<0.001; c-index 0.58). Finally, all recipient factors were used to create a simplified recipient risk index (RRI). This simplified RRI and ET-DRI were divided into three categories (low, medium, high). The combination of these two risk indices gave nine values, that were stronger correlated with outcome after OLT as compared to MELD-ET-DRI (Log-Rank p<0.001; c-index 0.71). The most hazardous combination (high-RRI with high-ET-DRI) had a HR of 5.5 as compared to the reference combination (low RRI-low ET-DRI).
Conclusion The combination of the ET-DRI with a simplified RRI is a very significant, predictive model of graft failure after liver transplantation. If graft survival is considered as the primary goal, this model could potentially be used as a tool for liver allocation.