Factors associated with the acceptance of livers for liver transplantation: validation of the Discard Risk Index in the Eurotransplant region

J.D. de Boer, H. Putter, J.J. Blok, N. Cambridge, S. van den Berg, U. Samuel, G. Berlakovich, M. Guba, A.E. Braat

Wednesday 13 march 2019

14:30 - 14:32h at Koningin Máximazaal

Categories: Basaal, Parallelsessie

Parallel session: Parallelsessie III - Basaal I

Background: Waiting list mortality remains an important issue although not all available liver allografts are used for transplantation. The utilization of available liver allografts might be further optimized with a better understanding of the reasons why livers are not transplanted. This study aims to analyze factors associated with the discarding of livers and to validate the prognostic ability of the Discard Risk Index (DSRI).

Methods: All donors that were reported to Eurotransplant from 01.01.2010 to 31.12.2015 were included. Liver utilization was defined by transplant status (y/n) and risk factors for discarding were identified. Based on this analysis, the ET-DSRI was developed in a training set. In the validation set, the ET-DSRI’s prognostic performance was analyzed and compared to the DSRI. Furthermore, reasons for discarding livers that were procured but not transplanted were analyzed.

Results: In the study period, 9,565 out of 11,670 potential livers (81%) were transplanted. Utilization rate remained stable throughout the study period although significant differences were observed between countries. Highest percentage of livers were used from donors from Croatia, while this percentage was lower in the Netherlands. Multivariable analysis identified the following risk factors for non-utilization: diabetes, history of a malignancy, vasopressors, history of drug abuse, male sex, BMI, age, DCD donor and higher laboratory values of sodium, INR, transaminases, bilirubin, gamma-glutamyl-transpeptidase (GGT) and a lower CRP. The newly developed ET-DSRI achieved a c-statistic of 0.77 in the training set compared to a c-statistic of 0.73 for the DSRI. In the validation set the ET-DSRI and DSRI achieved c-statistics of 0.75 and 0.72, respectively.

Conclusions: The ET-DSRI has the highest prognostic ability to predict liver utilization in a European setting. This model can provide a valuable tool to identify livers at high risk of not being transplanted in an early phase in the allocation process. This information might be useful for surgeons to evaluate an organ offer and offers opportunities to avoid organ loss. Allocation might be modified for these high-risk organs to minimize ischemic times and they