Abstract
Several studies have explored the risk of graft dysfunction after liver transplantation (LT) in recent years. Conversely, risk factors for graft discard before or at procurement have poorly been investigated. The study aimed at identifying a score to predict the risk of liver-related graft discard before transplantation. Secondary aims were to test the score for prediction of biopsy-related negative features and post-LT early graft loss. A total of 4207 donors evaluated during the period January 2004–Decemeber 2018 were retrospectively analyzed. The group was split into a training set (n = 3,156; 75.0%) and a validation set (n = 1,051; 25.0%). The Donor Rejected Organ Pre-transplantation (DROP) Score was proposed: − 2.68 + (2.14 if Regional Share) + (0.03*age) + (0.04*weight)-(0.03*height) + (0.29 if diabetes) + (1.65 if anti-HCV-positive) + (0.27 if HBV core) − (0.69 if hypotension) + (0.09*creatinine) + (0.38*log10AST) + (0.34*log10ALT) + (0.06*total bilirubin). At validation, the DROP Score showed the best AUCs for the prediction of liver-related graft discard (0.82; p < 0.001) and macrovesicular steatosis ≥ 30% (0.71; p < 0.001). Patients exceeding the DROP 90th centile had the worse post-LT results (3-month graft loss: 82.8%; log-rank P = 0.024).The DROP score represents a valuable tool to predict the risk of liver function-related graft discard, steatosis, and early post-LT graft survival rates. Studies focused on the validation of this score in other geographical settings are required.
Highlights
Liver transplantation (LT) is the best therapeutic strategy for managing more than 50 pathologies causing end-stage liver disease [1]
Many studies have focused on the risk of early graft dysfunction after transplantation [5–9], while interest has been observed in developing pre-procurement available prognosticators of scarce organ quality for transplant [3]
The present study illustrates a new score for the prediction of the risk of donors after brain death (DBD) liver-related graft discard
Summary
Liver transplantation (LT) is the best therapeutic strategy for managing more than 50 pathologies causing end-stage liver disease [1]. One of the main goals of transplant physicians is to maximize the pool of available liver grafts to increase. The current focus is on identifying predictive criteria to guide the safe use of liver grafts [3], since inappropriate graft selection might generate fatal consequences for the recipient [4]. Many studies have focused on the risk of early graft dysfunction after transplantation [5–9], while interest has been observed in developing pre-procurement available prognosticators of scarce organ quality for transplant [3]. This study aimed at identifying and validating a score to predict the risk of liver-related graft discard from donors after brain death (DBD). The secondary aim was to test the score for prediction of biopsy-related features and graft loss at 3 months after transplantation
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