Factors Associated with the Acceptance of Livers for Liver Transplantation: Validation of the Discard Risk Index in the Eurotransplant Region

J. D. Boer¹, H. Putter², J. J. Blok³, N. Cambridge¹, S. Van den Berg¹, U. Samuel¹, G. Berlakovich⁴, M. Guba⁵, A. E. Braat³

¹Eurotransplant International Foundation, Leiden, Netherlands, ²Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands, ³Transplant Center, Leiden University Medical Center, Leiden, Netherlands, ⁴Medical University of Vienna, Vienna, Austria, ⁵Hospital of the University of Munich, Munich, Germany

Meeting: 2019 American Transplant Congress

Abstract number: C290

Keywords: Allocation, Donors, marginal, High-risk, Liver grafts

Session Information

Session Name: Poster Session C: Liver: MELD, Allocation and Donor Issues (DCD/ECD)

Session Type: Poster Session

Date: Monday, June 3, 2019

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall C & D

*Purpose: In times of organ shortage it has to be better understood why available livers are not transplanted. This study aims to analyze factors associated with the discarding of livers and to validate the prognostic ability of the Discard Risk Index (DSRI).

*Methods: All deceased donors that were reported to Eurotransplant (ET) from 01.01.2010 to 31.12.2015 were included. Liver utilization was defined by transplant status (y/n) and risk factors for discarding were identified. Based on this analysis, the ET-DSRI was developed in a training set. In the validation set, the ET-DSRI’s prognostic performance was analyzed and compared to the DSRI. Furthermore, reasons for discarding livers that were procured but not transplanted were analyzed.

*Results: In the study period, 9,565 out of 11,670 potential livers (81%) were transplanted. Utilization rate remained stable throughout the study period although significant differences were observed between countries. Multivariable analysis identified the following risk factors for non-utilization: diabetes, history of a malignancy, vasopressors, history of drug abuse, male sex, BMI, age, DCD donor and higher laboratory values of sodium, INR, transaminases, bilirubin, gamma-glutamyl-transpeptidase (GGT) and a lower CRP. The newly developed ET-DSRI achieved a c-statistic of 0.75 compared to a c-statistic of 0.72 for the DSRI in the validation set.

*Conclusions: The ET-DSRI has the highest prognostic ability to predict liver utilization in a European setting. This model can provide a valuable tool to identify livers at high risk of not being transplanted in an early phase in the allocation process. It may be useful for surgeons to evaluate an organ offer and offers opportunities to avoid organ loss. Allocation might be modified for these high-risk organs that may also benefit most from advanced preservation techniques.

To cite this abstract in AMA style:

Boer JD, Putter H, Blok JJ, Cambridge N, Berg SVanden, Samuel U, Berlakovich G, Guba M, Braat AE. Factors Associated with the Acceptance of Livers for Liver Transplantation: Validation of the Discard Risk Index in the Eurotransplant Region [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/factors-associated-with-the-acceptance-of-livers-for-liver-transplantation-validation-of-the-discard-risk-index-in-the-eurotransplant-region/. Accessed May 8, 2025.

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