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273 DOES THE DONOR RISK INDEX INFLUENCE EARLY RECURRENCE OF HEPATITIS C FOLLOWING TRANSPLANTATION? K Wong, A Sinan, P Marotta BACKGROUND: Hepatitis C recurrence post-tranplantation is almost universal although the degree of histologic recurrence is variable. The cumulative probability of progressing to graft cirrhosis is 30% at 5 years. Many factors have been studied as potential predictors of recurrence including older donor age, immunosuppressive regimen, length of steroid use, allograft steatosis and genotype. Of these variables, only one is donor-related.
The donor risk index (DRI), comprising 8 donor risk factors, was recently described as a potential objective tool to guide organ acceptance. This index was derived from donor characteristics that predicted graft failure.
OBJECTIVE: The goal of this study was to determine whether early hepatitis C recurrence was associated with a higher donor risk index?
METHOD: Retrospective review of patients transplanted for hepatitis C at London Health Sciences Centre in London, Ontario between 1999-2004. Patients with early acute rejection, primary nonfunctioning grafts, multiple etiologies for end-stage liver disease (except alcohol), repeat transplant and HCC outside Milan criteria were excluded. Early recurrence was defined as presence of fibrosis on liver biopsy at 2 years or less. Donor characteristic were collected to calculate the donor risk index as published by Feng et al.
RESULTS: 51 patients were reviewed of which 24 (Group 1) had evidence of early recurrence and 27 (Group 2) did not. The mean DRI was 1.54±0.364 for Group 1 and 1.37±0.291 for Group 2. The donor risk index was not statistically different between the two groups (p=0.063) but there was a trend toward the DRI being higher in the Group 1. The DRI was <= 1.4 in 42% of patient in Group 1 versus 78% in Group 2 (p=0.008).
CONCLUSION: The donor risk index may help optimize donor selection for hepatitis C patients to reduce the risk of early recurrence, but a prospective study to validate the use of the DRI in this context would be required.