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Higher Donor Risk Index Linked to Liver Graft Failure

Last Updated: June 11, 2009.

The donor risk index appears to have a particularly adverse effect on outcomes in liver transplant recipients with hepatitis C virus, but liver grafts with steatosis don't seem to worsen three-year survival in patients with this infection, according to the results of two studies published in the June issue of Liver Transplantation.

THURSDAY, June 11 (HealthDay News) -- The donor risk index appears to have a particularly adverse effect on outcomes in liver transplant recipients with hepatitis C virus (HCV), but liver grafts with steatosis don't seem to worsen three-year survival in patients with this infection, according to the results of two studies published in the June issue of Liver Transplantation.

In the first study, Daniel G. Maluf, M.D., of the Virginia Commonwealth University in Richmond, and colleagues analyzed data from 16,678 liver transplant recipients in the Organ Procurement and Transplantation Network database, which included calculating the donor risk index from donor characteristics. Though increasing donor risk index was associated with an increase in the relative risk of graft failure and patient death in HCV-positive and negative patients, these risks grew higher in HCV-positive patients.

In the other study, Patrizia Burra, M.D., of the University of Padova in Italy, and colleagues analyzed data from 116 patients with or without HCV who underwent liver transplants with follow-up biopsies over the next three years. No steatosis was found in 50.9 percent of the grafts before transplantation, and steatosis was mild in 39.6 percent of samples. No correlation was seen between graft steatosis and later fibrosis, nor were differences seen in 36-month survival based on patients' HCV status or presence of steatosis in the graft.

"It is now possible to create an allocation algorithm that can systematically and objectively account for the variable impact of donor characteristics on liver transplant outcomes within the context of recipient diagnosis and disease severity. I believe that this would be the most equitable and transparent way to distribute the differential risk posed by the donor pool to individual transplant candidates," writes Sandy Feng, M.D., of the University of California in San Francisco, in an accompanying editorial.

Abstract - Maluf
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Abstract - Burra
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Editorial


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