Audrey Winter1,2, Cyrille Féray3, Etienne Audureau4, René Écochard5, Christian Jacquelinet6, Françoise Roudot-Thoraval3, Christophe Duvoux3, Jean-Pierre Daurès1,2, Paul Landais1,7. 1. Department of Biostatistics, UPRES EA2415, Clinical Research University Institute, University of Montpellier, Montpellier, France. 2. Beau Soleil Clinic, Languedoc Mutualité, Montpellier, France. 3. Department of Hepatology, Henri Mondor University Hospital, Créteil, France. 4. Department of Biostatistics and Public Health, Henri Mondor University Hospital, Créteil, France. 5. Laboratory Biostatistics-Health, CNRS 5558 - LBBE, Lyon, France. 6. Agence de la Biomédecine, Saint Denis, Villejuif, France. 7. Department of Biostatistics & Public Health, Nîmes University Hospital, Montpellier, France.
Abstract
BACKGROUND & AIMS: A major limitation to liver transplantation is organ shortage leading to the use of non-optimal liver grafts. The Donor Risk Index has been validated and recommended to select donors/organs. The Eurotransplant Donor Risk Index was derived from the Donor Risk Index. The objective of our study was to perform an external validation of both Donor Risk Index and Eurotransplant-Donor Risk Index against the French liver transplantation Cristal registry according to recommendations of the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis. METHODS: Liver transplantations performed in France between 2009 and 2013 were used to perform the validation study for the Donor Risk Index and the Eurotransplant-Donor Risk Index respectively. We applied on the French data the models used to construct the Donor Risk Index and the Eurotransplant-Donor Risk Index respectively. RESULTS: Neither the Donor Risk Index nor the Eurotransplant-Donor Risk Index were validated against this dataset. Discrimination and calibration of these scores were not preserved according to our data. Important donor and candidates differences between our dataset and the Organ Procurement and Transplantation Network or the Eurotransplant datasets may explain why the Donor Risk Index and the Eurotransplant-Donor Risk Index appeared unadapted to the French transplant registry. CONCLUSION: Neither of these risk indexes were suitable to optimize the French liver allocation system. Thus, our next step will be to propose a general adaptive model for a Donor Risk Index.
BACKGROUND & AIMS: A major limitation to liver transplantation is organ shortage leading to the use of non-optimal liver grafts. The Donor Risk Index has been validated and recommended to select donors/organs. The Eurotransplant Donor Risk Index was derived from the Donor Risk Index. The objective of our study was to perform an external validation of both Donor Risk Index and Eurotransplant-Donor Risk Index against the French liver transplantation Cristal registry according to recommendations of the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis. METHODS: Liver transplantations performed in France between 2009 and 2013 were used to perform the validation study for the Donor Risk Index and the Eurotransplant-Donor Risk Index respectively. We applied on the French data the models used to construct the Donor Risk Index and the Eurotransplant-Donor Risk Index respectively. RESULTS: Neither the Donor Risk Index nor the Eurotransplant-Donor Risk Index were validated against this dataset. Discrimination and calibration of these scores were not preserved according to our data. Important donor and candidates differences between our dataset and the Organ Procurement and Transplantation Network or the Eurotransplant datasets may explain why the Donor Risk Index and the Eurotransplant-Donor Risk Index appeared unadapted to the French transplant registry. CONCLUSION: Neither of these risk indexes were suitable to optimize the French liver allocation system. Thus, our next step will be to propose a general adaptive model for a Donor Risk Index.
Authors: Audrey Winter; Paul Landais; Daniel Azoulay; Mara Disabato; Philippe Compagnon; Corinne Antoine; Christian Jacquelinet; Jean-Pierre Daurès; Cyrille Féray Journal: JHEP Rep Date: 2020-05-04