Donor Factors Predicting Recipient Survival After Liver Retransplantation: The Retransplant Donor Risk Index

• Published in: American journal of transplantation Vol. 7; no. 8; pp. 1984 - 1988
• Main Authors: Northup, P. G., Pruett, T. L., Kashmer, D. M., Argo, C. K., Berg, C. L., Schmitt, T. M.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-08-2007; Blackwell
• Subjects: Adult; Age Factors; Aged; Biological and medical sciences; Epidemiology; Extended criteria donation; Female; Follow-Up Studies; General aspects; graft failure; hepatitis C; Hepatitis C virus; Human viral diseases; Humans; Infectious diseases; liver donor allocation; Liver Failure - surgery; liver retransplantation; Liver Transplantation - mortality; Male; Medical sciences; Middle Aged; Prognosis; Public health. Hygiene; Public health. Hygiene-occupational medicine; Reoperation - mortality; Retrospective Studies; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Rate - trends; Tissue Donors; United States - epidemiology; Viral diseases; Viral hepatitis; United States; USA; Suboptimal donor; Prognosis; hepatitis C; Hepatic disease; Risk; Transplantation; Index; Homotransplantation; Epidemiology; Allocation; Criterion; Surgery; Donation; Graft; Viral hepatitis C; Human; Reoperation; Digestive system; Recipient; Survival; liver donor allocation; Attribution; Graft failure; Extended criteria donation; Infection; liver retransplantation; Treatment; Viral disease; Risk factor; Digestive diseases; Organ
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2007.01887.x

The use of extended criteria liver donors (ECD) is controversial, especially in the setting of retransplantation. The aims of this study are to investigate the effects of ECD grafts on retransplantation and to develop a predictive mortality index in liver retransplantation based on the previously established donor risk index. The United Network for Organ Sharing (UNOS) liver transplant dataset was analyzed for all adult, non‐status 1, liver retransplantations occurring in the United States since February 2002. All donors were categorized for multiple characteristics of ECD, and using multivariate survival models a retransplant donor risk index (ReTxDRI) was developed. A total of 1327 retransplants were analyzed. There were 611 (46%) recipients who received livers with at least one ECD criterion. The use of ECD grafts in recipients with HCV did not incur worse survival than the non‐ECD grafts. The addition of the cause of recipient graft failure to the donor risk index formed the ReTxDRI. After adjusting for multiple recipient factors, the ReTxDRI was predictive of overall recipient survival and was a strongly independent predictor of death after retransplantation (HR 2.49, 95% CI 1.89–3.27, p < 0.0001). The use of the ReTxDRI can improve recipient and donor matching and help to optimize posttransplant survival in liver retransplantation.
Several donor factors are predictive of recipient mortality after liver retransplantation and a predictive index (the ReTxDRI) can help define the specific risk imparted by a donor, especially in hepatitis C positive recipients.