The UK-DCD-Risk-Score - practical and new guidance for allocation of a specific organ to a recipient?

ABSTRACT

Introduction: Multiple factors contribute to the overall outcome in donation after circulatory death liver transplantation. The majority is however inconsistently reported with various acceptance criteria and thresholds, when to decline a specific graft. Recent improvement in outcome was based on an increased awareness of the cumulative risk, combining donor and recipient parameters, which encouraged the community to accept livers with an overall higher risk.

Areas covered: This review pictures the large number of risk factors in this field with a special focus on parameters, which contribute to available prediction models. Next, features of the recently developed UK-DCD-Risk-Score, which led to a significantly impaired graft survival, above a suggested threshold of >10 score points, are discussed. The clinical impact of this new model on the background of other prediction tools with their subsequent limitations is highlighted in a next chapter. Finally, we provide suggestions, how to further improve outcomes in this challenging field of transplantation.

Expert opinion: Despite the recent development of new prediction models, including the UK-DCD-Risk-Score, which provides a sufficient prediction of graft loss after DCD liver transplantation, the consideration of other confounders is essential to better understand the overall risk and metabolic liver status to improve the comparability of clinical studies. More uniform definitions and thresholds of individual risk factors are required.

KEYWORDS:

• Donation after circulatory death
• allocation
• risk factors
• donor-recipient match
• UK-DCD-Risk-Score

Highlight Box

• Difficulties in understanding the overall and metabolic risk of DCD grafts with subsequent logistic challenges contribute to the high percentage of unutilized DCD donors and livers.

• Uniform definitions of risk factors are essential.

• Available prediction models identify donor-recipient combinations with an overall too high risk, however refinement of current score systems is required.

• The UK-DCD-Risk-Score appears easy to calculate and superior to other models in terms of graft survival prediction at a defined threshold of >10points.

• The role of several risk factors remains unclear, because many parameters are not available in large databases.

• Better assessment tools and new biomarkers are needed to avoid underestimation of risk, improve DCD liver quality and increase the utilization of grafts previously declined for transplantation.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.