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Updated: Feb 26, 2026
Technique of Subnormothermic Ex Vivo Liver Perfusion for the Storage, Assessment, and Repair of Marginal Liver Grafts
Published on: August 13, 2014
Developing a donation after cardiac death risk index for adult and pediatric liver transplantation
Shirin Elizabeth Khorsandi1, Emmanouil Giorgakis1, Hector Vilca-Melendez1
1Shirin 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.
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).
