The Donor Risk Index Does Not Accurately Classify Patients With or Without Graft Failure

E. Franco,¹ T. Athanasios,² N. Kemmer,³ L. Leone,¹ A. Alsina,¹ B. Djulbegovic.²

¹Surgery, TGMG/USF Morsani College of Medicine, Tampa, FL
²Internal Medicine, Morsani College of Medicine, USF, Morsani College of Medicine, Tampa, FL
³Hepatology, TGMG/USF Morsani College of Medicine, Tampa, FL.

Meeting: 2015 American Transplant Congress

Abstract number: C108

Keywords: Donors, Liver, marginal, Outcome, Prediction models

Session Information

Session Name: Poster Session C: Liver Donation and Allocation

Session Type: Poster Session

Date: Monday, May 4, 2015

Session Time: 5:30pm-6:30pm

Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

In liver transplantation assessing risk of donor is paramount to graft survival. The donor risk index (DRI) was introduced as a predictor of graft failure using donor and transplant characteristics applying a cox regression model. Here, we attempt to validate the DRI using recipient operator characteristics (ROC) analysis.

Methods: The Organ Procurement and Transplant Network database was used for the analysis from January 1, 2003 trough December 31, 2012. Recipient and donor data was collected. Pediatrics and multiple organ transplants were excluded. Cox regression analysis was used to verify previous findings. The area under the ROC curve was used to evaluate accuracy of the DRI at 90 days, 1 year and 3 years. Statistical analysis was done using SAS.

Results: 51,100 adults were transplanted from deceased donors during the study period. Table 1 shows the donor demographic data. Donors age greater than 50 comprised 35% of the donor pool and 60% were male. Stroke was the cause of death in 42% and DCD comprised 6.36%.


Donor Factor	Frequency	Percent
Age
0-17	3,476	6.8
18-39	19,200	37.57
40-49	10,102	19.77
50-59	10,030	19.63
60-69	5,786	11.32
+70	2,506	4.9
Female	20,771	40.65
Race
African American	8,442	16.52
White	34,384	67.29
Other	8,258	16.16
Unknown	16	0.03
Partial/Split	387	1.33
Cause of Death
Trauma	18,826	36.84
Stroke	21,531	42.14
Anoxia	9,416	18.43
Other	1325	2.59
Unknown	2	0
DCD	3,251	6.36
Height (cm)	Mean 171.54

Table 1. Donor Characteristics

Graft survival frequencies range from 74% to 84% at 3 years. Figure 1 depicts the ROC curves for graft survival at three different time intervals. The area under the ROC curve was for 90-day, 1-year and 3-year was 0.5577, 0.5521, and 0.5580 respectively.

Conclusion: The donor risk index does not accurately discriminate graft failure using ROC analysis. The area under the ROC curve with a value of 0.5 does not have ability to discriminate between graft failure and survival.

To cite this abstract in AMA style:

Franco E, Athanasios T, Kemmer N, Leone L, Alsina A, Djulbegovic B. The Donor Risk Index Does Not Accurately Classify Patients With or Without Graft Failure [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/the-donor-risk-index-does-not-accurately-classify-patients-with-or-without-graft-failure/. Accessed May 12, 2025.

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