Hepatitis C rather than Donor Risk Index is major contributor to poor graft survival in transplant patients

The Donor Risk Index, which assesses donor characteristics impacting liver transplantation outcomes, does not bear the same impact on outcomes on a small scale as is suggested from large-scale, national data.

Rather, hepatitis C was shown to continue to be the major contributor to poor graft survival in transplant patients, according to a Henry Ford Hospital.

The goals of the study were to confirm the effect of the Donor Risk Index on liver transplant recipients and to evaluate further donor and recipient characteristics on transplant outcomes.

"We found the risks to be small for individual characteristics influencing outcomes except for hepatitis C," says Marwan Abouljoud, M.D., director of Henry Ford Hospital's Transplant Institute and lead author of the study.

"Looking at data from large studies is like looking under a microscope and when the information from many of these national studies is translated to day-to-day practice, the information often doesn't prove to be practical, especially when you consider patients are dying on transplant waiting lists."

Study results were presented today at the International Congress of The Transplantation Society in Vancouver.

The study looked at the DRI scores for 100 liver transplants between January and December 2008, analyzing recipients and their corresponding donors. Donor and recipient demographics, model for end-stage liver disease (MELD) scores, laboratory data, operative factors and pathologists were reviewed.

The presence of hepatitis in recipients post-transplant was found to have the biggest impact on mortality and graft failure. Death rate was 22 percent, of which 41 percent died due to recurrent hepatitis. The graft failure rate was 20 percent with hepatitis the cause in 44 percent of the cases.

The only Donor Risk Index subcategory that was associated with graft loss in the study was high donor age, says Dr. Abouljoud, who suggests that further study is needed to favorably impact graft survival within the context of the Donor Risk Index.

"Our findings suggest that the focus should be on the combined factors that effect organ quality and function, not one individual characteristic," says Dr. Abouljoud.

Currently, almost 16,000 people in the United States are waiting for liver transplants, according to the Health Resources and Services Administration. About 5,300 liver transplantations were performed in the United States in 2002.