Donor Risk Index and MELD Score Interactions in Graft Survival Prediction after Liver Transplantation. An Analysis of the OPTN-UNOS Database

Donor Risk Index (DRI) has been introduced to predict post-transplant graft survival (GS) using donor data. The MELD score, which is the gold-standard in scoring liver disease in liver transplant candidates, has a low prognostic significance. The present analysis is aimed to assess the role of DRI and of MELD score in predicting the outcome after liver transplantation, in short (180 days) and medium term (1460 days). The Organ Procurement Transplantation Network (OPTN) database relevant to 23.392 consecutive cases in the MELD era was used. Cases were stratified in classes according to DRI (4 classes), MELD (6 classes), and DRI-MELD match (24 classes). GS was assessed by Kaplan Meier method at 0-1460 days. Differences were tested by Log-rank test. All three parameters allow an effective stratification. Using the DRI, the gaps between the highest and lowest GS were 7.8% and 14.9%, at 180 and 1460 days, respectively. Using the MELD score, the gaps were 10.2% and 9.5%, respectively. Using DRI-MELD, the gaps were 25.5% and 35.4%, respectively. Both the DRI and the MELD can predict the outcome, although the predictive power of the DRI is the highest of the two, and the predictive power of the donor- recipient match, is even higher.