Scheuermann Uwe, Truong Tracy, Seyferth Elisabeth R, Freischlag Kyle, Gao Qimeng, Yerxa John, Ezekian Brian, Davis Robert P, Schroder Paul M, Peskoe Sarah B, Barbas Andrew S
Department of Surgery, Duke University Medical Center, Durham, NC.
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC.
Transplant Direct. 2019 Nov 25;5(12):e511. doi: 10.1097/TXD.0000000000000955. eCollection 2019 Dec.
The most established metric for estimating graft survival from donor characteristics in liver transplantation is the liver donor risk index (LDRI). The LDRI is calculated from donor and transplant-related variables, including cold ischemic time. Because cold ischemic time is unknown at the time of organ offer, LDRI is not available for organ acceptance decisions. In contrast, the kidney donor profile index (KDPI) is derived purely from donor variables known at the time of offer and thus calculated for every deceased donor in the United States. The similarity in donor factors included in LDRI and KDPI led us to hypothesize that KDPI would reliably approximate LDRI in estimating graft survival in liver transplantation.
The United Network of Organ Sharing registry was queried for adults who underwent deceased donor liver transplantation from 2002 to 2016. The cohort was divided into quintiles of KDPI and LDRI, and graft survival was calculated according to Kaplan Meier. Hazard ratios for LDRI and KDPI were estimated from Cox proportional hazards models, and Uno's concordance statistic was compared.
In our analysis of 63 906 cases, KDPI closely approximated LDRI in estimating liver graft survival, with an equivalent concordance statistic of 0.56.
We conclude that KDPI can serve as a reasonable alternative to LDRI in liver acceptance decisions.
在肝移植中，根据供体特征评估移植物存活的最成熟指标是肝脏供体风险指数（LDRI）。LDRI是根据供体和移植相关变量计算得出的，包括冷缺血时间。由于在器官供出时冷缺血时间未知，LDRI无法用于器官接受决策。相比之下，肾脏供体特征指数（KDPI）完全由供出时已知的供体变量得出，因此在美国为每位已故供体计算该指数。LDRI和KDPI中包含的供体因素相似，这使我们推测KDPI在估计肝移植移植物存活方面能够可靠地近似LDRI。
查询器官共享联合网络登记处，获取2002年至2016年接受已故供体肝移植的成年人信息。将该队列按KDPI和LDRI分为五分位数，并根据Kaplan Meier法计算移植物存活率。从Cox比例风险模型估计LDRI和KDPI的风险比，并比较Uno一致性统计量。
在我们对63906例病例的分析中，KDPI在估计肝移植物存活方面与LDRI非常接近，一致性统计量为0.56。
我们得出结论，在肝脏接受决策中，KDPI可以作为LDRI的合理替代指标。
