Khorsandi SE, Giorgakis E, Vilca-Melendez H, O’Grady J, Heneghan M, Aluvihare V, Suddle A, Agarwal K, Menon K, Prachalias A, Srinivasan P, Rela M, Jassem W, Heaton N. Developing a donation after cardiac death risk index for adult and pediatric liver transplantation. World J Transplant 2017; 7(3): 203-212 [PMID: 28698837 DOI: 10.5500/wjt.v7.i3.203]
Corresponding Author of This Article
Nigel Heaton, Professor, Institute of Liver Studies, King’s College Hospital, London SE5 9RS, United Kingdom. nigel.heaton@nhs.net
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Jun 24, 2017; 7(3): 203-212 Published online Jun 24, 2017. doi: 10.5500/wjt.v7.i3.203
Developing a donation after cardiac death risk index for adult and pediatric liver transplantation
Shirin Elizabeth Khorsandi, Emmanouil Giorgakis, Hector Vilca-Melendez, John O’Grady, Michael Heneghan, Varuna Aluvihare, Abid Suddle, Kosh Agarwal, Krishna Menon, Andreas Prachalias, Parthi Srinivasan, Mohamed Rela, Wayel Jassem, Nigel Heaton
Shirin Elizabeth Khorsandi, Emmanouil Giorgakis, Hector Vilca-Melendez, John O’Grady, Michael Heneghan, Varuna Aluvihare, Abid Suddle, Kosh Agarwal, Krishna Menon, Andreas Prachalias, Parthi Srinivasan, Mohamed Rela, Wayel Jassem, Nigel Heaton, Institute of Liver Studies, King’s College Hospital, London SE5 9RS, United Kingdom
Author contributions: Khorsandi SE designed and wrote study; Giorgakis E performed the analysis and was involved in writing the manuscript; Vilca-Melendez H, O’Grady J, Heneghan M, Aluvihare V, Suddle A, Agarwal K, Menon K, Prachalias A, Srinivasan P, Rela M and Jassem W were all involved in the editing and review of the manuscript; Heaton N provided guidance in the manuscript composition and gave final institutional approval.
Institutional review board statement: There was institutional approval for the present work.
Conflict-of-interest statement: None of the authors have any conflict of interest declare that is applicable to the present manuscript.
Data sharing statement: No additional data is available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nigel Heaton, Professor, Institute of Liver Studies, King’s College Hospital, London SE5 9RS, United Kingdom. nigel.heaton@nhs.net
Telephone: +44-20-32994801 Fax: +44-20-32993575
Received: November 18, 2016 Peer-review started: November 23, 2016 First decision: December 29, 2016 Revised: January 21, 2017 Accepted: March 12, 2017 Article in press: March 13, 2017 Published online: June 24, 2017 Processing time: 216 Days and 3.7 Hours
Abstract
AIM
To identify objective predictive factors for donor after cardiac death (DCD) graft loss and using those factors, develop a donor recipient stratification risk predictive model that could be used to calculate a DCD risk index (DCD-RI) to help in prospective decision making on organ use.
METHODS
The model included objective data from a single institute DCD database (2005-2013, n = 261). Univariate survival analysis was followed by adjusted Cox-regressional hazard model. Covariates selected via univariate regression were added to the model via forward selection, significance level P = 0.3. The warm ischemic threshold was clinically set at 30 min. Points were given to each predictor in proportion to their hazard ratio. Using this model, the DCD-RI was calculated. The cohort was stratified to predict graft loss risk and respective graft survival calculated.
RESULTS
DCD graft survival predictors were primary indication for transplant (P = 0.066), retransplantation (P = 0.176), MELD > 25 (P = 0.05), cold ischemia > 10 h (P = 0.292) and donor hepatectomy time > 60 min (P = 0.028). According to the calculated DCD-RI score three risk classes could be defined of low (DCD-RI < 1), standard (DCD-RI 2-4) and high risk (DCD-RI > 5) with a 5 years graft survival of 86%, 78% and 34%, respectively.
CONCLUSION
The DCD-RI score independently predicted graft loss (P < 0.001) and the DCD-RI class predicted graft survival (P < 0.001).
Core tip: Calculating the donor after cardiac death (DCD) Risk Index score using objective variables from the donor (cold ischemic time, warm ischemic time, donor hepatectomy time) and from the selected recipient (primary indication for transplant, model for end-stage liver disease, retransplantation) can help rationalize the risk of using a DCD liver in a given recipient in order to produce good results.
