Donor Risk Index (DRI) has been introduced to predict post-transplant graft survival (GS) using donor data. The MELD score, which is the gold-standard in scoring liver disease in liver transplant candidates, has a low prognostic significance. The present analysis is aimed to assess the role of DRI and of MELD score in predicting the outcome after liver transplantation, in short (180 days) and medium term (1460 days). The Organ Procurement Transplantation Network (OPTN) database relevant to 23.392 consecutive cases in the MELD era was used. Cases were stratified in classes according to DRI (4 classes), MELD (6 classes), and DRI-MELD match (24 classes). GS was assessed by Kaplan Meier method at 0-1460 days. Differences were tested by Log-rank test. All three parameters allow an effective stratification. Using the DRI, the gaps between the highest and lowest GS were 7.8% and 14.9%, at 180 and 1460 days, respectively. Using the MELD score, the gaps were 10.2% and 9.5%, respectively. Using DRI-MELD, the gaps were 25.5% and 35.4%, respectively. Both the DRI and the MELD can predict the outcome, although the predictive power of the DRI is the highest of the two, and the predictive power of the donorrecipient match, is even higher. The combination of DRI and MELD represents the best prognostic index in both short and medium-term observation period. On the basis of our results we believe that, in order to increase GS without refusing donors with high DRI, we should not allocate these organs to patients with a high MELD score.
Donor Risk Index and MELD score interactions in graft survival prediction after liver transplantation. An analysis of the OPTN-UNOS database
BARONE, Michele
2011-01-01
Abstract
Donor Risk Index (DRI) has been introduced to predict post-transplant graft survival (GS) using donor data. The MELD score, which is the gold-standard in scoring liver disease in liver transplant candidates, has a low prognostic significance. The present analysis is aimed to assess the role of DRI and of MELD score in predicting the outcome after liver transplantation, in short (180 days) and medium term (1460 days). The Organ Procurement Transplantation Network (OPTN) database relevant to 23.392 consecutive cases in the MELD era was used. Cases were stratified in classes according to DRI (4 classes), MELD (6 classes), and DRI-MELD match (24 classes). GS was assessed by Kaplan Meier method at 0-1460 days. Differences were tested by Log-rank test. All three parameters allow an effective stratification. Using the DRI, the gaps between the highest and lowest GS were 7.8% and 14.9%, at 180 and 1460 days, respectively. Using the MELD score, the gaps were 10.2% and 9.5%, respectively. Using DRI-MELD, the gaps were 25.5% and 35.4%, respectively. Both the DRI and the MELD can predict the outcome, although the predictive power of the DRI is the highest of the two, and the predictive power of the donorrecipient match, is even higher. The combination of DRI and MELD represents the best prognostic index in both short and medium-term observation period. On the basis of our results we believe that, in order to increase GS without refusing donors with high DRI, we should not allocate these organs to patients with a high MELD score.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
