Race and receipt of liver transplantation: Location matters

Asrani, Sumeet K.; Kim, Woojin; Kamath, Patrick S.

doi:10.1002/lt.22123

Cited by 9 publications

(7 citation statements)

References 17 publications

(32 reference statements)

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“…In addition, in the current study donor race/ethnicity was associated with post-transplant survival with higher hazard ratios associated with Asian and Hispanic donors. Asrani et al reported similar results in a mixed liver transplant cohort of 10,874 patients, but the results were not significant when adjusted for donor age, height, HBV status and transplant center [ 29 ]. Still, there is evidence that a racial/ethnic mismatch between donor and recipient in HCV infected patients is associated with increased risk for graft failure [ 30 ].…”

Section: Discussionmentioning

confidence: 94%

Liver transplantation for chronic hepatitis C virus infection in the United States 2002–2014: An analysis of the UNOS/OPTN registry

Dultz¹,

Graubard²,

Martin³

et al. 2017

PLoS ONE

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Chronic hepatitis C virus (HCV) infection is a leading cause for orthotopic liver transplantation (OLT) in the U.S. We investigated characteristics of HCV-infected patients registered for OLT, and explored factors associated with mortality. Data were obtained from the United Network for Organ Sharing and Organ Procurement and Transplantation network (UNOS/ OPTN) registry. Analyses included 41,157 HCV-mono-infected patients !18 years of age listed for cadaveric OLT between February 2002 and June 2014. Characteristics associated with pre-and post-transplant survival and time trends over the study period were determined by logistic and Cox proportional hazard regression analyses and Poisson regressions. Most patients were white (69.1%) and male (70.8%). At waitlist registration, mean age was 54.6 years and mean MELD was 16. HCC was recorded in 26.9% of the records. A total of 51.2% of the patients received an OLT, 21.0% died or were too sick; 15.6% were delisted and 10.4% were still waiting. Factors associated with increased waitlist mortality were older age, female gender, blood type 0, diabetes, no HCC and transplant region (p<0.001). OLT recipient characteristics associated with increased risk for post OLT mortality were female gender, age, diabetes, race (p<0,0001), and allocation MELD (p = 0.005). Donor characteristics associated with waitlist mortality included age, ethnicity (p<0.0001) and diabetes (p<0.03). Waitlist registrations and OLTs for HCC significantly increased from 14.4% to 37.3% and 27.8% to 38.5%, respectively (p<0.0001). Pre-and post-transplant survival depended on a variety of patient-, donor-, and allocation-characteristics of which most remain relevant in the DAA-era. Still, intensified HCV screening strategies and timely and effective treatment of HCV are highly relevant to reduce the burden of HCV-related OLTs in the U.S.

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Section: Discussionmentioning

confidence: 94%

Liver transplantation for chronic hepatitis C virus infection in the United States 2002–2014: An analysis of the UNOS/OPTN registry

Dultz¹,

Graubard²,

Martin³

et al. 2017

PLoS ONE

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“…For example, though biliary complications are higher in patients with higher DRI, biliary complications are higher at centers that accept organs with lower donor age and lower DRI among DCD organs, suggesting a center‐level effect that may not be captured by DRI . Similarly, the impact of donor race may be explained by center of transplantation . The impact of DRI on organ failure may vary by region and center of transplant, especially after incorporation of Share 35 .…”

Section: Limitations and Barriers To Acceptancementioning

confidence: 99%

The donor risk index: A decade of experience

Flores

Asrani

2017

Liver Transpl

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In 2006, derivation of the donor risk index (DRI) highlighted the importance of donor factors for successful liver transplantation. Over the last decade, the DRI has served as a useful metric of donor quality and has enhanced our understanding of donor factors and their impact upon recipients with hepatitis C virus, those with low Model for End-Stage Liver Disease (MELD) score, and individuals undergoing retransplantation. DRI has provided the transplant community with a common language for describing donor organ characteristics and has served as the foundation for several tools for organ risk assessment. It is a useful tool in assessing the interactions of donor factors with recipient factors and their impact on posttransplant outcomes. However, limitations of statistical modeling, choice of donor factors, exclusion of unaccounted donor and geographic factors, and the changing face of the liver transplant recipient have tempered its widespread use. In addition, the DRI was derived from data before the MELD era but is currently being applied to expand the donor pool while concurrently meeting the demands of a dynamic allocation system. A decade after its introduction, DRI remains relevant but may benefit from being updated to provide guidance in the use of extended criteria donors by accounting for the impact of geography and unmeasured donor characteristics. DRI could be better adapted for recipients with nonalcoholic fatty liver disease by examining and including recipient factors unique to this population. Liver Transplantation 23 1216-1225 2017 AASLD.

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“…Regions with the longest wait times tend to transplant organs with higher LDRIs. Differences in donor quality among the 11 OPTN/UNOS regions have led to disparate rates of allograft survival 42. Recently, even center‐based differences in posttransplant outcomes have been examined as a function of donor quality.…”

Section: Donor Risk Indices In Liver Transplantationmentioning

confidence: 99%

Development of organ-specific donor risk indices

et al. 2012

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Due to the shortage of deceased donor organs, transplant centers accept organs from marginal deceased donors, including older donors. Organ-specific donor risk indices have been developed to predict graft survival using various combinations of donor and recipient characteristics. We will review the kidney donor risk index (KDRI) and liver donor risk index (LDRI) and compare and contrast their strengths, limitations, and potential uses. The Kidney Donor Risk Index has a potential role in developing new kidney allocation algorithms. The Liver Donor Risk Index allows for greater appreciation of the importance of donor factors, particularly for hepatitis C-positive recipients; as the donor risk index increases, rates of allograft and patient survival among these recipients decrease disproportionately. Use of livers with high donor risk index is associated with increased hospital costs independent of recipient risk factors, and transplanting livers with high donor risk index into patients with Model for End-Stage Liver Disease scores < 15 is associated with lower allograft survival; use of the Liver Donor Risk Index has limited this practice. Significant regional variation in donor quality, as measured by the Liver Donor Risk Index, remains in the United States. We also review other potential indices for liver transplant, including donor-recipient matching and the retransplant donor risk index. While substantial progress has been made in developing donor risk indices to objectively assess donor variables that affect transplant outcomes, continued efforts are warranted to improve these indices to enhance organ allocation policies and optimize allograft survival.

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Race and receipt of liver transplantation: Location matters

Cited by 9 publications

References 17 publications

Liver transplantation for chronic hepatitis C virus infection in the United States 2002–2014: An analysis of the UNOS/OPTN registry

Liver transplantation for chronic hepatitis C virus infection in the United States 2002–2014: An analysis of the UNOS/OPTN registry

The donor risk index: A decade of experience

Development of organ-specific donor risk indices

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