Objectives: The utilization of liver allografts could be optimized if nonacceptance is predicted. This study aimed to evaluate the prognostic ability of an updated Discard Risk Index in... Show moreObjectives: The utilization of liver allografts could be optimized if nonacceptance is predicted. This study aimed to evaluate the prognostic ability of an updated Discard Risk Index in Eurotransplant.Materials and Methods: Potential deceased donors from January 2010 to December 2015 who had been reported to Eurotransplant were included in our analyses. Liver utilization was defined by transplant status as the primary outcome to evaluate the performance of the Eurotransplant-developed Discard Risk Index.Results: Of 11 670 potential livers, 9565 (81%) were actually transplanted. Donor sex, age, history of diabetes, drug abuse, use of vasopressors, body mass index category, serum sodium, cause of death, donor type, and levels of C-reactive protein, bilirubin, aspartate and alanine aminotransferases, international normalized ratio, and gamma-glutamyl transpeptidase were associated with discard and combined in the Eurotransplant-developed Discard Risk Index. Correlation between the two Discard Risk Indexes was high (r = 0.86), and both achieved high C statistics of 0.72 and 0.75 (P <.001), respectively. Despite strong calibration, discard rates of 0.8% for overall donors and 6% of donors after circulatory death could be predicted with 80% accuracy.Conclusions: The Eurotransplant-developed Discard Risk Index showed a high prognostic ability to predict liver utilization in a European setting. The model could therefore be valuable for identifying livers at high risk of not being transplanted in an early stage. These organs might profit the most from modified allocation strategies or advanced preservation techniques. Show less
In this thesis the impact of donor and recipient risk factors and the development of risk models in liver transplantation was investigated. These models can be used for multiple purposes, including... Show moreIn this thesis the impact of donor and recipient risk factors and the development of risk models in liver transplantation was investigated. These models can be used for multiple purposes, including risk indication, outcome prediction and benchmarking between transplant centers. As such, several steps have been made towards evidence-based liver allocation and proper selection of liver allografts in times of organ shortage and the current system of severitybased liver allocation (by MELD the score). Further refinement of these models is necessary in order to optimize donor to recipient matching and achieve an objective, transparent and well-informed system of liver allocation. Altogether, the efforts made here to improve waitlist and transplantation outcomes, are meant for the individual transplant candidate on the liver transplant waitlist and as a whole, for the transplant community. Show less
