The summaries are free for public
use. The Chronic Liver Disease
Foundation will continue to add and
archive summaries of articles deemed
relevant to CLDF by the Board of
Trustees and its Advisors.
Abstract Details
Donor risk index for african american liver transplant recipients with hepatitis C virus
Shores NJ, Dodge JL, Feng S, Terrault NA. Hepatology. 2013 May 20. doi: 10.1002/hep.26478. [Epub ahead of print]
Source
Tulane University, New Orleans, LA. Nshores@tulane.edu.
Abstract
African-American (AA) liver transplant (LT) recipients with hepatitis C virus (HCV) have higher rates of graft loss than other racial/ethnic groups. The Donor Risk Index (DRI) predicts graft loss but is neither race nor disease-specific and may not be optimal for assessing donor risk for AA HCV-positive LT recipients. We developed a DRI for AA with HCV with the goal of enhancing graft loss predictions. All U.S. HCV-positive adult AA first deceased donor LTs surviving ≥30 days from 3/2002 to 12/2009 were included. A total of 1766 AA LT recipients were followed for median 2.8 (IQR 1.3-4.9) years. Independent predictors of graft loss were donor age (40-49 yrs: HR 1.54; 50-59 yrs: HR 1.80; 60+ yrs: HR 2.34, p<0.001), non-AA donor (HR 1.66, p<0.001) and cold ischemia time (CIT) (HR 1.03 per hour >8 hours, p=0.03). Importantly, the negative effect of increasing donor age on graft and patient survival among AAs was attenuated by receipt of an AA donor. A new donor risk model for AA (AADRI-C) consisting of donor age, race and CIT yielded 1, 3 and 5-year predicted graft survival rates of 91, 77 and 68% for AADRI <1.60; 86, 67 and 55% for AADRI 1.60-2.44; and 78, 53 and 39% for AADRI >2.44. In the validation dataset, AADRI-C correctly reclassified 27% of patients (net reclassification improvement p=0.04) compared to the original DRI. We conclude that AADRI-C identifies grafts at higher risk of failure and this information is useful for risk-benefit discussions with recipients. Use of AA donors allows consideration of older donors.