The Liver Outcome Monitoring Registry Donor Risk Index: A New Measure of Deceased Donor Liver Quality

S. Kurian¹, J. Case¹, A. Robinson², B. Barrick¹, M. Prentice², C. Marsh¹

¹Scripps Center for Organ and Cell Transplantation, La Jolla, CA, ²United Network for Organ Sharing Research Department, Richmond, VA

Meeting: 2020 American Transplant Congress

Abstract number: 480

Keywords: Allocation, Liver, Outcome

Session Information

Session Name: Liver: Recipient Selection

Session Type: Oral Abstract Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:45pm

Presentation Time: 3:51pm-4:03pm

Location: Virtual

*Purpose: The liver donor risk index (LDRI) created in 2006 evaluated the relative risk of graft failure, however its weaknesses have limited its use in the modern era. UNOS, with our transplant center created a new metric, the Liver Outcome Monitoring Registry-donor risk index (LOMR-DRI), using OPTN data. LOMR-DRI uses a recent cohort of liver transplants spanning 2015 to 2017 and a multivariable Cox proportional hazards model to predict one-year graft survival adjusting for both donor and recipient characteristics.

*Methods: We compared:1. LOMR-DRI adjusting for recipient and donor characteristics (LOMR-DRI (D+R)); 2. LOMR-DRI adjusting for donor characteristics (LOMR-DRI (D)); and 3. LDRI adjusting for donor characteristics (LDRI). LOMR-DRI informs organ acceptance based on information known at the time of offer to address the limitations of the LDRI. The LOMR-DRI used deceased donor liver transplants in recipients >18 yrs (April 2015 and March 2017; training cohort). All scores were tested on two naïve validation cohorts of patients before (April 2014 – March 2015) and after (April 2017 – January 2018) the training cohort, using same exclusionary criteria.

*Results: One-year graft survival did not differ among the cohorts. LOMR-DRI (D+R) had the highest c-statistic for all cohorts with only a slight drop in the testing cohorts. LOMR-DRI (D) and the LDRI performed similarly on all three cohorts. Kaplan Meier survival curves by quartiles showed a statistically significant difference in graft survival across quartiles using the LOMR-DRI (D+R). The LOMR-DRI (D) showed separation of quartiles on both testing cohorts, however there was no difference in survival using LDRI on the second testing cohort.

*Conclusions: LOMR-DRI (D+R) performed better than the existing LDRI and the LOMR-DRI (D) was on par with the LDRI. This suggests donor characteristics alone are not adequate for understanding liver transplant survival variation and that recipient characteristics also influence transplant success. LOMR-DRI inherently accounts for both recipient and donor quality and may be a useful tool to balance equity and utility in liver allocation

C-Statistic and 95% Confidence Interval by Score and Cohort
Score	04/2015-03/2017	04/2015-03/2017	04/2017-01/2018
LOMR-DRI (D+R)	0.60 (0.58-0.63)	0.64 (0.62-0.66)	0.59 (0.56-0.62)
LOMR-DRI (D)	0.54 (0.52-0.57)	0.57 (0.55-0.58)	0.52 (0.49-0.55)
LDRI	0.55 (0.52-0.57	0.55 (0.53-0.57)	0.51 (0.48-0.53)

To cite this abstract in AMA style:

Kurian S, Case J, Robinson A, Barrick B, Prentice M, Marsh C. The Liver Outcome Monitoring Registry Donor Risk Index: A New Measure of Deceased Donor Liver Quality [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/the-liver-outcome-monitoring-registry-donor-risk-index-a-new-measure-of-deceased-donor-liver-quality/. Accessed November 22, 2024.

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