Published online Jun 24, 2017. doi: 10.5500/wjt.v7.i3.203
Peer-review started: November 23, 2016
First decision: December 29, 2016
Revised: January 21, 2017
Accepted: March 12, 2017
Article in press: March 13, 2017
Published online: June 24, 2017
Processing time: 216 Days and 3.7 Hours
To identify objective predictive factors for donor after cardiac death (DCD) graft loss and using those factors, develop a donor recipient stratification risk predictive model that could be used to calculate a DCD risk index (DCD-RI) to help in prospective decision making on organ use.
The model included objective data from a single institute DCD database (2005-2013, n = 261). Univariate survival analysis was followed by adjusted Cox-regressional hazard model. Covariates selected via univariate regression were added to the model via forward selection, significance level P = 0.3. The warm ischemic threshold was clinically set at 30 min. Points were given to each predictor in proportion to their hazard ratio. Using this model, the DCD-RI was calculated. The cohort was stratified to predict graft loss risk and respective graft survival calculated.
DCD graft survival predictors were primary indication for transplant (P = 0.066), retransplantation (P = 0.176), MELD > 25 (P = 0.05), cold ischemia > 10 h (P = 0.292) and donor hepatectomy time > 60 min (P = 0.028). According to the calculated DCD-RI score three risk classes could be defined of low (DCD-RI < 1), standard (DCD-RI 2-4) and high risk (DCD-RI > 5) with a 5 years graft survival of 86%, 78% and 34%, respectively.
The DCD-RI score independently predicted graft loss (P < 0.001) and the DCD-RI class predicted graft survival (P < 0.001).
Core tip: Calculating the donor after cardiac death (DCD) Risk Index score using objective variables from the donor (cold ischemic time, warm ischemic time, donor hepatectomy time) and from the selected recipient (primary indication for transplant, model for end-stage liver disease, retransplantation) can help rationalize the risk of using a DCD liver in a given recipient in order to produce good results.