NIV Congres
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The Eurotransplant Donor Risk Index distribution amongst MELD categories within the Eurotransplant region
Blok, J.J., Ringers, J., Rahmel, A., Rogiers, X., Putter, H., Braat, A.E.
Categorie(ën):
Introduction Recently we introduced the Eurotransplant Donor Risk Index (ET-DRI) as indicator of donor quality within the Eurotransplant region. Since donor quality is only one side of the story, a combination of the ET-DRI with recipient characteristics (e.g. MELD) would possibly better predict outcome after orthotopic liver transplantation (OLT). OBJECTIVE Investigation of the distribution of the ET-DRI throughout different liver transplant recipient groups and combination of ET-DRI with several recipient factors as predictor of outcome after OLT.
Methods All liver transplants within the Eurotransplant region in adult (≥18) recipients performed from 1.1.2008 till 31.12.2010 were retrospectively analysed.
Results A total of 4489 liver transplants were performed. Distribution of transplantations with lab-MELD and exception-MELD were 73% (N=3290) vs. 26% (N=1176) (unknown N=23). Donor and recipient risk were (median): ET-DRI 1.91, DRI 1.78, lab-MELD 23 (N=3290), exception-MELD 26 (N=1176), overall lab-MELD 18 overall and match-MELD 25. Distribution of lab-MELD transplantations was: MELD6-14 23%, MELD15-20 20%, MELD21-25 11%, MELD26-30 12%, MELD 31-35 14% and MELD≥35 20%. Distribution of exception-MELD categories was: MELD20-25 49%, MELD26-30 37%, MELD31-35 10% and MELD>35 4%. ET-DRI significantly (p=0.001) predicted outcome in Kaplan-Meier survival analysis and in multivariate Cox-regression analysis (p<0.001) (when correcting for all available recipient factors). ET-DRI (median) distribution among lab-MELD categories was respectively: ET-DRI 2.02, ET-DRI 1.88, ET-DRI 1.87, ET-DRI 1.87, ET-DRI 1.88 and ET-DRI 1.87. The use of high-risk ET-DRI allografts (ET-DRI>1.91) led to a significant (p≤0.004) difference in outcome in the low-MELD (6-14) and medium-MELD (26-30) groups. In the exception-MELD categories the ET-DRI distribution was respectively: ET-DRI 1.94, ET-DRI 1.92, ET-DRI 1.93 and ET-DRI 1.72. The use of high-risk ET-DRI allografts did not led to a significant difference in outcome in any of the groups.
Conclusion The ET-DRI was validated as risk score in this recent database. There is a trend towards the use of high ET-DRI allografts in lower (lab and exception) MELD categories and lower ET-DRI allografts in the high exception MELD category. The use of high-risk allografts leads to a significant difference in outcome in the lowest lab-MELD category. It is questionable whether high ET-DRI allografts should be used for lower lab-MELD categories.