Development of organ-specific donor risk indices§

Authors

  • Sanjeev K. Akkina,

    1. Department of Medicine, University of Illinois, Chicago, IL
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    • These authors contributed equally to this work.

  • Sumeet K. Asrani,

    1. Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN
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    • These authors contributed equally to this work.

  • Yi Peng,

    1. Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
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  • Peter Stock,

    1. Department of Surgery, University of California San Francisco, San Francisco, CA
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  • W. Ray Kim,

    1. Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN
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  • Ajay K. Israni

    Corresponding author
    1. Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
    2. Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
    3. Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
    • Department of Medicine, Hennepin County Medical Center, University of Minnesota, 701 Park Avenue, Minneapolis, MN 55415-1829
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    • Telephone: 612-347-5871; FAX: 612-347-2003


  • This work was supported by the Scientific Registry of Transplant Recipients. The Scientific Registry of Transplant Recipients is funded by a contract from the Health Resources and Services Administration (US Department of Health and Human Services). The views expressed herein are those of the authors and are not necessarily those of the US Government.

  • This is a US Government–sponsored work. There are no restrictions on its use.

  • §

    This study was approved by the Scientific Registry of Transplant Recipients project officer of the Health Resources and Services Administration.

  • Sanjeev K. Akkina was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (grant K23DK084121).

Abstract

Because of the shortage of deceased donor organs, transplant centers accept organs from marginal deceased donors, including older donors. Organ-specific donor risk indices have been developed to predict graft survival with various combinations of donor and recipient characteristics. Here we review the kidney donor risk index (KDRI) and the liver donor risk index (LDRI) and compare and contrast their strengths, limitations, and potential uses. The KDRI has a potential role in developing new kidney allocation algorithms. The LDRI allows a greater appreciation of the importance of donor factors, particularly for hepatitis C virus–positive recipients; as the donor risk index increases, the rates of allograft and patient survival among these recipients decrease disproportionately. The use of livers with high donor risk indices is associated with increased hospital costs that are independent of recipient risk factors, and the transplantation of livers with high donor risk indices into patients with Model for End-Stage Liver Disease scores < 15 is associated with lower allograft survival; the use of the LDRI has limited this practice. Significant regional variations in donor quality, as measured by the LDRI, remain in the United States. We also review other potential indices for liver transplantation, including donor-recipient matching and the retransplant donor risk index. Although substantial progress has been made in developing donor risk indices to objectively assess donor variables that affect transplant outcomes, continued efforts are warranted to improve these indices to enhance organ allocation policies and optimize allograft survival. Liver Transpl 18:395–404, 2012. © 2012 AASLD.

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