Baylor University Medical Center, Baylor Scott and White Heath, Dallas, Texas, USA.
Baylor College of Medicine, Houston, Texas, USA.
Am J Transplant. 2022 Dec;22(12):2921-2930. doi: 10.1111/ajt.17191. Epub 2022 Sep 22.
Accurate assessment of donor quality at the time of organ offer for liver transplantation candidates may be inadequately captured by the donor risk index (DRI). We sought to develop and validate a novel objective and simple model to assess donor risk using donor level variables available at the time of organ offer. We utilized national data from candidates undergoing primary LT (2013-2019) and assessed the prediction of graft failure 1 year after LT. The final components were donor Insulin-dependent diabetes mellitus, Donor type (DCD or DBD), cause of Death = CVA, serum creatinine, Age, height, and weight (length). The ID EAL score had better discrimination than DRI using bootstrap corrected concordant index over time, especially in the current era. We explored donor-recipient matching. Relative risk of graft failure ranged from 1.15 to 3.5 based on relevant donor-recipient matching by the ID EAL score. As an example, for certain recipients, a young DCD donor offer was preferable to an older DBD with relevant comorbidities. The ID EAL score may serve as an important tool for patient discussion about donor risk and decisions regarding offer acceptance. In addition, the score may be preferable to succinctly capture donor risk in future organ allocation that considers continuous distribution (www.iddealscore.com).
在为肝移植候选人提供器官时，对供体质量的准确评估可能无法通过供体风险指数（DRI）充分捕捉。我们试图开发和验证一种新的客观且简单的模型，使用供体提供时可用的供体水平变量来评估供体风险。我们利用 2013 年至 2019 年期间进行原发性 LT 的候选人的国家数据，并评估了 LT 后 1 年移植物失败的预测。最终的组成部分是供体胰岛素依赖型糖尿病、供体类型（DCD 或 DBD）、死因=CVA、血清肌酐、年龄、身高和体重（长度）。ID EAL 评分的 bootstrap 校正一致性指数的判别能力优于 DRI，尤其是在当前时代。我们探索了供体-受体匹配。根据 ID EAL 评分的相关供体-受体匹配，移植物失败的相对风险范围为 1.15 至 3.5。例如，对于某些受体，年轻的 DCD 供体提供比具有相关合并症的年长 DBD 更好。ID EAL 评分可作为与患者讨论供体风险以及接受供体提供相关决定的重要工具。此外，该评分可能优于在考虑连续分布的情况下（www.iddealscore.com）简洁地捕获未来器官分配中的供体风险。
