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Donor risk index predicts graft failure reliably but not post-transplant infections

Laura H Rosenberger1, Jacob R Gillen, Tjasa Hranjec

  • 11 Department of Surgery, University of Virginia Health System , Charlottesville, Virginia.

Surgical Infections
|November 29, 2013
PubMed
Abstract

Insights

The Donor Risk Index (DRI) does not predict post-transplant infections. Instead, recipient factors, not graft quality indicated by DRI, are key to infectious complications after liver transplants.

Area of Science:

  • Hepatology
  • Transplantation Immunology
  • Infectious Diseases

Background:

  • The Donor Risk Index (DRI) is established for predicting liver graft survival.
  • Its utility in predicting post-transplant infectious complications remains unexplored.
  • This study investigates the hypothesis that lower-quality grafts (higher DRI) correlate with increased infectious complications.

Purpose of the Study:

  • To determine if the Donor Risk Index (DRI) predicts post-operative infectious complications in liver transplant recipients.
  • To compare infectious complication rates between low-DRI and high-DRI liver allografts.

Main Methods:

  • A prospectively collected dataset of liver transplant recipients and their post-transplant infectious complications was utilized.
  • Recipients were stratified into low-DRI and high-DRI groups based on allograft DRI scores.
  • Statistical analysis, including logistic regression, was performed to identify predictors of infection.

Main Results:

  • 378 liver transplants were analyzed, with 189 recipients in each low-DRI and high-DRI group.
  • No significant difference in the mean number of infectious complications per patient was observed between the low-DRI (1.60±0.19) and high-DRI (1.94±0.24) groups (p=0.26).
  • Logistic regression identified hospital stay duration and history of vascular disease as independent predictors of infection, with a trend for MELD score.

Conclusions:

  • The Donor Risk Index (DRI) is not a significant predictor of post-operative infectious complications in liver transplant recipients.
  • Infectious complications following liver transplantation are more strongly associated with recipient-specific factors rather than donor graft quality as measured by DRI.
  • Recipient factors, including length of hospital stay and pre-existing vascular disease, play a more critical role in post-transplant infections.

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