A modified liver donor risk index for pediatric liver transplant recipients

The liver donor risk index (LDRI) was developed by Feng et al to predict the quality of donor liver allografts. However, there is currently no literature documenting the application and efficacy of Feng's LDRI specifically for the pediatric population. The goal of our study is to apply Feng's LDRI to our study population as well as develop a pediatric-specific LDRI. De-identified data from the United Network for Organ Sharing for 7836 recipients with pediatric transplant were retrospectively analyzed from January 1, 2000, to July 1, 2022. We performed a univariate and multivariate Cox regression analysis to determine the significant recipient and transplant factors impacting pediatric liver allograft survival. These significant factors were used to construct the pediatric-specific LDRI index. Receiver operator characteristic curve analysis was utilized to compare the pediatric-specific and Feng LDRI indexes at 1, 5, and 10 years.​​ Our pediatric-specific LDRI includes 4 variables found to be significant in pediatric populations: donor age: 35-50, ≥ 50; cold ischemia time ≤ 6, and aspartate aminotransferase level > 1000. In addition, our pediatric-specific LDRI had a higher receiver operator characteristic c -statistic compared to Feng's LDRI at 1 year (0.57 vs. 0.55), 5 years (0.57 vs. 0.50), and 10 years (0.58 vs. 0.47). Our findings indicate that there is a need to create a pediatric-specific LDRI as the Feng LDRI has not been shown to be efficacious in pediatric populations. Our index may serve as a starting point for the development of a comprehensive pediatric LDRI.