Prognostic limitations of the Eurotransplant-donor risk index in liver transplantation

Journal of Negative Results in Biomedicine

Harald Schrem³  Alon Goldis¹  Alexander Kaltenborn⁴  Benedikt Reichert² 

[1] Lean Six Sigma Black Belt, LM Advisors, Amstelveen, Netherlands;General and Thoracic Surgery, Universitätsklinikum Schleswig Holstein, Kiel, Germany;Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany;Federal Armed Forces Medical Center Hannover, Hannover, Germany

关键词: Validation;    Prediction;    Score;    Goodness-of-fit;    Accuracy;    Prognostic model;   

Others  :  812329
DOI  :  10.1186/1477-5751-12-18

 received in 2013-06-12, accepted in 2013-12-22,  发布年份 2013

【 摘 要 】

Background

Liver transplantation is the only life-saving therapeutic option for end-stage liver disease. Progressive donor organ shortage and declining donor organ quality justify the evaluation of the leverage of the Donor-Risk-Index, which was recently adjusted to the Eurotransplant community’s requirements (ET-DRI). We analysed the prognostic value of the ET-DRI for the prediction of outcome after liver transplantation in our center within the Eurotransplant community.

Results

291 consecutive adult liver transplants were analysed in a single centre study with ongoing data collection. Determination of the area under the receiver operating characteristic curve (AUROC) was performed to calculate the sensitivity, specificity, and overall correctness of the Eurotransplant-Donor-Risk-Index (ET-DRI) for the prediction of 3-month and 1-year mortality, as well as 3-month and 1-year graft survival. Cut-off values were determined with the best Youden-index. The ET-DRI is unable to predict 3-month mortality (AUROC: 0.477) and 3-month graft survival (AUROC: 0.524) with acceptable sensitivity, specificity and overall correctness (54% and 56.3%, respectively). Logistic regression confirmed this finding (p = 0.573 and p = 0.163, respectively). Determined cut-off values of the ET-DRI for these predictions had no significant influence on long-term patient and graft survival (p = 0.230 and p = 0.083, respectively; Kaplan-Meier analysis with Log-Rank test).

Conclusions

The ET-DRI should not be used for donor organ allocation policies without further evaluation, e.g. in combination with relevant recipient variables. Robust and objective prognostic scores for donor organ allocation purposes are desperately needed to balance equity and utility in donor organ allocation.

【 授权许可】

   
2013 Reichert et al.; licensee BioMed Central Ltd.

【 图 表 】

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