Prognostic Evaluation of the Donor Risk Index Among a Prospective Cohort of Italian Patients Undergoing Liver Transplantation

• Published in: Transplantation proceedings Vol. 41; no. 4; pp. 1096 - 1098
• Main Authors: Vitale, A, D'Amico, F, Gringeri, E, Valmasoni, M, Pauletto, A, Bonsignore, P, Bassi, D, D'Amico, F.E, Polacco, M, Burra, P, Russo, F, Angeli, P, Poci, C, Feltracco, P, Romano, A, Cillo, U
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 01.05.2009; Elsevier
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Child; Donor Selection; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft Survival; Humans; Liver Diseases - surgery; Liver Transplantation; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Miscellaneous; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; Risk Assessment; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tissue, organ and graft immunology; Treatment Outcome; Young Adult; Italy; Europe; Suboptimal donor; Human; Evaluation; Italian; Prognosis; Digestive system; Liver; Patient; Risk; Index; Homotransplantation; Medicine; Prospective; Treatment; Surgery; Cohort study; Risk factor; Graft; Public health; Liver transplantation
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2009.03.097

Abstract Background/Aim The definition of an extended criteria donor for orthotopic liver transplantation (OLT) remains controversial. The donor risk index (DRI) has become the main tool to define the marginality of hepatic grafts in the United States. The aim of this study was to prospectively evaluate the prognostic ability of DRI among a cohort of Italian patients undergoing OLT. Methods From December 2006 to March 2008, we prospectively calculated DRI in all consecutive cadaveric grafts. Recipient inclusion criteria were: adult patients with chronic liver disease enlisted for primary OLT. The primary end point was the incidence of primary graft dysfunction (PDF), namely, aspartate aminotransferase (AST) >2000 U/mL and prothrombin time <40% on postoperative days 2–7. Results We enrolled 74 donor–recipient pairs fulfilling the inclusion criteria. Donor characteristics included DRI 1.7 (range, 0.9–3.0); age 57 years (range, 18–81); ultrasound signs of steatosis in 22 donors (30%); and ischemia time was 536 minutes (range, 290–690). Recipient characteristics are: age 55 years (range, 27–68); hepatocellular carcinoma in 36 subjects (49%); MELD was 16 (range, 7–39); and Child-Pugh score was 8 (range, 6–14). In terms of the primary end points, the DRI did not provide a significant PDF predictor ( P = .84). Among all evaluated donor and recipient variables, the following were related to the incidence of graft PDF: donor age ( P = .07), ultrasound signs of steatosis ( P = .02), donor AST ( P = .05), cell saver infusion ( P = .07), and warm ( P = .04) and cold ischemia ( P = .07) times. Conclusion The preliminary data of this study showed a poor correlation between DRI and PDF incidence after OLT.