A Donor Quality Index for liver transplantation: development, internal and external validation

Area of Science:

• Hepatology
• Transplantation immunology
• Medical informatics

Background:

• Organ shortage necessitates the use of non-optimal liver grafts for transplantation.
• Existing donor risk indices, such as the Donor Risk Index and Eurotransplant Donor Risk Index, lack validation in the French population.
• There is a need for an improved tool to assess liver graft quality for transplantation decisions.

Purpose of the Study:

• To develop and validate an adaptive Donor Quality Index (DQI) for liver grafts using French liver transplantation data.
• To identify donor characteristics that predict graft quality and patient outcomes.
• To establish risk groups based on the DQI to guide clinical decision-making.

Main Methods:

• Retrospective analysis of 3961 liver transplantations (LT) in France (2009-2013) for model development.
• External validation using 1048 French LT performed in 2014.
• Development of the DQI using Cox models and selection methods, incorporating donor age, cause of death, ICU stay, MDRD creatinine clearance, and liver type.
• Assessment of model performance using discrimination measures and bootstrap validation.

Main Results:

• A novel Donor Quality Index (DQI) was developed, incorporating five key donor covariates.
• The DQI successfully discriminated three distinct risk groups.
• Internal validation demonstrated satisfactory model performance.
• External validation confirmed preserved calibration and discrimination, indicating robustness.
• The DQI showed good properties for aiding liver graft selection.

Conclusions:

• The developed adaptive Donor Quality Index (DQI) is a validated tool for assessing liver graft quality in the French context.
• The DQI can assist in better decision-making for liver transplantation, potentially improving graft utilization.
• Further application of the DQI may help optimize donor selection and enhance post-transplant outcomes.