DONOR RISK INDEX-LIVER GRAFT DONOR RISK INDEX-LIVER GRAFT SURVIVAL ASSOCIATION IN PATIENTS SURVIVAL ASSOCIATION IN PATIENTS

OVER 18 YEARS OF AGE IN OVER 18 YEARS OF AGE IN ARGENTINAARGENTINA

Bisigniano Liliana MD., López-Rivera Arturo MD., Tagliafichi Viviana, Fernández Víctor J MD., Soratti Carlos A MD.

Introduction

• Due to the larger number of patients waiting for a liver transplant, the limits for the use of organs available have been expanded worldwide.

• The donor risk index (DRI) uses donor variables proven to be associated with graft survival in liver transplantation in patients over 18.

Introduction

An analysis must be conducted to define the potential effect of certain features of the

donor on graft survival. The Risk Index in Cadaveric Donors (RICD)

was designed based on this idea.

Objective

To assess, by means of an adequate statistical analysis, whether the RICD is an independent predictor of liver graft survival

To analyze the association between the donor risk index score and graft survival en liver transplantation in patients over 18 years of age in Argentina.

Materials & Methods

• The information was obtained from the SINTRA for the period July 2005 to December 2010

• Multiorgan transplants were excluded

• The statistical packages used were MedCal version 10.3.2.0 and SPSS version 17.

Materials & Methods

We estimated the graft survival at 30 days, 1 and 5 years using the nonparametric Kaplan-Meier method.By using the Cox regression model, the relationship of the DRI with graft survival adjusted for the following variables of the recipient was studied:

INDEPENDET VARIABLESAge

BMI (>18.5,<25,<30,>30)Etiology of liver failure

Blood type compatibility

Materials & Methods

Graft survival at 30 days, 1 and 5 years usingthe nonparametric Kaplan-Meier method. By using the Cox regression model:relationship of the DRI with graft survival adjusted for the followingvariables of the recipient:

BMI (>18.5,<25,<30,>30), etiology of liver failure, blood type compatibility

The clinical condition was not used (only 4 patients in emergency.

Materials & Methods

DONOR RISK INDEX

AGE <40-<50 <50-<60 <60-<70 >70

CAUSE OF DEATH ANOXIA STROKE ≠ HEAD TRAUMA

RACE BLACK ≠ Caucasian

CARDIAC ARREST Yes No

SPLIT Yes No

ALLOCATION National Regional

CIT < 8hours > 8hours

DRI values were coded into 6 categories

No values between 0 and 1.2

1 1.2-1.42 1.4-1.53 1.5-1.64 1.6-1.85 1.8-2.06 >2.0

Results

RECIPIENT MEAN AGE 51.04+ 12.72 YEARS

  GRAFT ER

30 days 86.1% 0.0108

1 year 77.4% 0.0138

5 years 58.1% 0.297

1116 transplant procedures were performed

Results Survival curve

0 2 4 6 8 10 12 14

100

90

80

70

60

50

40

30

20

10

0

Follow up time in years

Sur

viva

l pro

babi

lity

(%)

Number at risk1501 898 562 341 207 90 21 1

30 days 1 year 5 years86.1% 77.4% 58.1%

Results

HR CI 95% pCategory 2 1.04 0.63-1.72 0.883Category 3 1.10 0.64-1.89 0.98Category 4 0.98 0.57-1.70 0.984Category 5 0.99 0.57-1.70 0.984Category 6 0.86 0.50-1.46 0.563

We evaluated the association of each of the categories of DRI with graft survival adjusted according to the rest of the variables by using the Cox regression model.

All the categories were compared vs category 1

Conclusions

• The scores of the DRI have no association with graft survival in liver transplantation in patients over 18 years of age in the Argentine population.

• Studies to design a DRI with data from the Argentine donors should be performed.