Tulane University, New Orleans, LA. Nshores@tulane.edu.
African-American (AA) liver transplant (LT) recipients with hepatitis C virus (HCV) have higher rates of graft loss than other racial/ethnic groups. The Donor Risk Index (DRI) predicts graft loss but is neither race nor disease-specific and may not be optimal for assessing donor risk for AA HCV-positive LT recipients. We developed a DRI for AA with HCV with the goal of enhancing graft loss predictions. All U.S. HCV-positive adult AA first deceased donor LTs surviving ≥30 days from 3/2002 to 12/2009 were included. A total of 1766 AA LT recipients were followed for median 2.8 (IQR 1.3-4.9) years. Independent predictors of graft loss were donor age (40-49 yrs: HR 1.54; 50-59 yrs: HR 1.80; 60+ yrs: HR 2.34, p<0.001), non-AA donor (HR 1.66, p<0.001) and cold ischemia time (CIT) (HR 1.03 per hour >8 hours, p=0.03). Importantly, the negative effect of increasing donor age on graft and patient survival among AAs was attenuated by receipt of an AA donor. A new donor risk model for AA (AADRI-C) consisting of donor age, race and CIT yielded 1, 3 and 5-year predicted graft survival rates of 91, 77 and 68% for AADRI <1.60; 86, 67 and 55% for AADRI 1.60-2.44; and 78, 53 and 39% for AADRI >2.44. In the validation dataset, AADRI-C correctly reclassified 27% of patients (net reclassification improvement p=0.04) compared to the original DRI. We conclude that AADRI-C identifies grafts at higher risk of failure and this information is useful for risk-benefit discussions with recipients. Use of AA donors allows consideration of older donors.