Feng et al developed a donor risk index (DRI) to evaluate the liver donor for factors that impact liver graft failure in the recipient. The authors are from the University of San Francisco, University of Michigan, University of Medicine and Dentistry of New Jersey and Albert Einstein College of Medicine.
Patient selection: liver donor
Parameters:
(1) donor age in years
(2) cause of death (COD)
(3) race
(4) donation after cardiac death (DCD)
(5) status of donor liver
(6) height in centimeters
(7) transplant network type
(8) cold time in hours
|
Parameter |
Finding |
Points |
|
donor age |
< 40 years |
0 |
|
|
40 to 49.99 |
0.154 |
|
|
50 to 59.99 |
0.274 |
|
|
60 to 69.99 |
0.424 |
|
|
>= 70 |
0.50 |
|
cause of death |
anoxia |
0.079 |
|
|
stroke (CVA) |
0.145 |
|
|
trauma |
0 |
|
|
other (not trauma, stroke or anoxia) |
0.184 |
|
race |
African American |
0.176 |
|
|
White |
0 |
|
|
other |
0.126 |
|
donation after cardiac death |
no |
0 |
|
|
yes |
0.411 |
|
status of donor liver |
intact |
0 |
|
|
partial or split |
0.422 |
|
transplant network |
regional share |
0.105 |
|
|
national share |
0.244 |
|
|
local |
0 |
where:
• The other category for race and cause of death is ambiguous. The categories in Table 2 are used.
points for height =
= 0.066 * (170 – (height in cm)) / 10 =
= 0.0066 * (170 – (height in cm))
points for cold time =
= (0.010 * (cold time in hours)
X =
= SUM(points for all of the parameters)
donor risk index =
= EXP(X)
Interpretation:
• minimum DRI: near 0
• The higher the DRI the worse the graft survival.
• In 1998-2002 the 3 year graft survival was 81% for a DRI <= 1.0 but 60% if DRI > 2.0.
Specialty: Gastroenterology, Surgery, general
