CAN DONOR RISK INDEX PREDICT RECIPIENT SURVIVAL OF ASIAN LIVER DONORS? A CANADIAN PILOT STUDY

Search CDDW 2008 Abstracts

182

CAN DONOR RISK INDEX PREDICT RECIPIENT SURVIVAL OF ASIAN LIVER DONORS? A CANADIAN PILOT STUDY

K Tsoi, M Bloch, W Wall, P Marotta
Multiorgan Transplant Program, London Health Science Centre, London ON

INTRODUCTION: Organ donation rates of Asians, including liver, are significantly lower than the general Canadian population. Extended criteria donors represent a means of increasing organ availability. Recently a Donor Risk Index (DRI) was developed as a tool to predict survival post liver transplantation. In this index ethnicity of donor includes “Caucasians”, “African Americans” and “others” which include “Asians”. Given distinct genetic makeup of Asians, we aim to determine whether a separate “Asian” group should be adapted for DRI calculation.
METHODS: Consecutive non-Caucasian liver donors from the London Health Science Centre in Ontario, Canada were selected between 1999 and 2007. For every donor in this cohort, 2 Caucasian donors transplanted within three months were selected as matched controls. Kaplan-Meier survival curves were generated and compared to predicted survival rates using DRI scores.
RESULTS: Of the number of liver transplants in this time period, twenty-one successful liver transplantations using non-Caucasian donors were identified. Four African Canadians and one Latin Canadian were excluded. Sixteen donors as well as thirty-two Caucasians controls were further analyzed. For patient survival at three years, the actual and estimated survival rate for Asians were 79.3% and 67.6% respectively (p=NS). A smaller difference was observed in the Caucasian control cohort (71.2% vs 69.9%, p=NS)

Ethnicity of Donors Asians (n=16) Caucasians (n=32)
Donor Risk Index – median (range) 1.67 (1.11-2.10) 1.64 (0.85-2.46)
% survival at 3 months [95% CI] Actual 93.7 [88.7-99.8] 89.8 [84.2-95.4]
Estimate* 84.7 [82.9-86.5] 85.8 [84.2-87.4]
% survival at 1 year [95% CI] Actual 79.3 [68.6-90.0] 79.4 [71.9-86.9]
Estimate* 77.5 [75.4-79.6] 78.9 [77.1-80.9]
% survival at 3 years [95% CI] Actual 79.3 [68.6-90.0] 70.9 [62.1-79.7]
Estimate* 67.6 [65.2-70.2] 69.9 [67.5-72.1]
*UNOS database (Feng S et al (2006) American Journal of Transplantation)
CONCLUSION: By treating “Asians” as “others”, DRI trends towards underestimating recipient survival in this small Asian cohort. Further studies from an Asian predominant cohort are needed to properly validate DRI in predicting graft and patient survival with marginal Asian donors.

PREVIOUS NEXT

Ethnicity of Donors		Asians (n=16)	Caucasians (n=32)
Donor Risk Index – median (range)		1.67 (1.11-2.10)	1.64 (0.85-2.46)
% survival at 3 months [95% CI]	Actual	93.7 [88.7-99.8]	89.8 [84.2-95.4]
	Estimate*	84.7 [82.9-86.5]	85.8 [84.2-87.4]
% survival at 1 year [95% CI]	Actual	79.3 [68.6-90.0]	79.4 [71.9-86.9]
	Estimate*	77.5 [75.4-79.6]	78.9 [77.1-80.9]
% survival at 3 years [95% CI]	Actual	79.3 [68.6-90.0]	70.9 [62.1-79.7]
	Estimate*	67.6 [65.2-70.2]	69.9 [67.5-72.1]