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. 2013 Dec 24:12:18.
doi: 10.1186/1477-5751-12-18.

Prognostic limitations of the Eurotransplant-Donor Risk Index in liver transplantation

Benedikt Reichert, Alexander Kaltenborn  1 , Alon Goldis, Harald Schrem
Affiliations

Prognostic limitations of the Eurotransplant-Donor Risk Index in liver transplantation

Benedikt Reichert et al. J Negat Results Biomed. .

Abstract

Background: Liver transplantation is the only life-saving therapeutic option for end-stage liver disease. Progressive donor organ shortage and declining donor organ quality justify the evaluation of the leverage of the Donor-Risk-Index, which was recently adjusted to the Eurotransplant community's requirements (ET-DRI). We analysed the prognostic value of the ET-DRI for the prediction of outcome after liver transplantation in our center within the Eurotransplant community.

Results: 291 consecutive adult liver transplants were analysed in a single centre study with ongoing data collection. Determination of the area under the receiver operating characteristic curve (AUROC) was performed to calculate the sensitivity, specificity, and overall correctness of the Eurotransplant-Donor-Risk-Index (ET-DRI) for the prediction of 3-month and 1-year mortality, as well as 3-month and 1-year graft survival. Cut-off values were determined with the best Youden-index. The ET-DRI is unable to predict 3-month mortality (AUROC: 0.477) and 3-month graft survival (AUROC: 0.524) with acceptable sensitivity, specificity and overall correctness (54% and 56.3%, respectively). Logistic regression confirmed this finding (p = 0.573 and p = 0.163, respectively). Determined cut-off values of the ET-DRI for these predictions had no significant influence on long-term patient and graft survival (p = 0.230 and p = 0.083, respectively; Kaplan-Meier analysis with Log-Rank test).

Conclusions: The ET-DRI should not be used for donor organ allocation policies without further evaluation, e.g. in combination with relevant recipient variables. Robust and objective prognostic scores for donor organ allocation purposes are desperately needed to balance equity and utility in donor organ allocation.

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Figures

Figure 1
Figure 1
Shown is the ROC-Curve for the prediction of 3-month mortality after liver transplantation with the ET-DRI (AUROC = 0.477; 95%CI: 0.390-0.564).
Figure 2
Figure 2
Kaplan Meier survival analysis above and below the ET-DRI cut-off values for the prediction of 3-month mortality (2.06) shows that this cut-off value has no significant influence on long-term survival (p = 0.172; Log Rank). The curve clearly demonstrates that the ET-DRI has no influence on long-term survival and limited influence on survival within the first 90 days.
Figure 3
Figure 3
Shown is the ROC-Curve for the prediction of 3-month graft survival after liver transplantation with the ET-DRI (AUROC of 0.524 (95%CI: 0.447-0.601, SD 0.039).
Figure 4
Figure 4
Kaplan Meier survival analysis above and below the ET-DRI cut-off values for the prediction of 3-month graft survival (1.95) shows that this cut-off value has no significant influence on long-term graft survival (p = 0.655; Log Rank). The curve clearly demonstrates that the ET-DRI has no influence on long-term graft survival.
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