The donor risk index: A decade of experience

Abstract

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.

A preoperative nomogram predicts prognosis of patients with hepatocellular carcinoma after liver transplantation: A multicenter retrospective study

“…However, it has been well-validated to guide organ allocation policy and to identify patients who are at risk of death because of end-stage liver disease [11] . In general, organs with a high donor risk index (DRI) should be transplanted into patients with a low MELD score of 10-14 [12,13] . However, subsequent data showed that patients with high MELD scores could also bene t from sub-optimal organ transplants [14][15][16] ; therefore, we included the entire range of MELD scores into our model.…”

“Real‐time” risk models of postoperative morbidity and mortality for liver transplants

“…Although marginal allograft, such as severe steatosis and extended ischemia time, might influence the postoperative morbidity and mortality in deceased donors, in the present study, we used exclusively donor age and graft volume as donor variables. In the majority of cases, allograft qualities such as cold ischemic time, steatosis, and fibrosis were sufficient and not marginal as a result of the nature of LDLT, which represented the majority of LT in this cohort.…”

“…The postoperative clinical course after LT should be determined by preoperative/postoperative recipient conditions and donor allograft conditions. Many studies have investigated the preoperative and intraoperative risk factors of recipient‐related or allograft‐related DDLT and LDLT recipients . However, to our knowledge, a large population study investigating both recipient and donor allograft conditions based on registry data has not been carried out to date.…”

Assessment of Liver Graft Steatosis: Where Do We Stand?

“…However, this model has many limitations, such as an inability to assess the degree of injury that is caused by the process of graft procurement or cold preservation and reperfusion. Also, it is applicable to the US donor population but is not readily transferable to populations in other countries . In order to face the limitations of DRI, novel statistical models have been developed, such as the UK donor liver index and the balance of risk (BAR) score.…”