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Factors Associated With Short- and Long-term Liver Graft Survival in the United Kingdom: Development of a UK Donor Liver Index

Collett, David PhD; Friend, Peter J. MD; Watson, Christopher J. E. MD

doi: 10.1097/TP.0000000000001576
Original Clinical Science—Liver

Background A measure of donor liver quality, the donor liver index, was developed and validated for the UK population of transplant recipients. Unlike previously proposed measures, this index is only based on variables that are available at the point of retrieval, and so does not include cold ischemic time.

Methods Indices of liver quality were based on data from the UK Transplant Registry on all 7929 liver transplants between January 2000 and December 2014.

Results The donor liver index (DLI) was based on factors shown to affect graft survival, which included donor age, sex, height, type (donor after brain death or circulatory death), bilirubin, smoking history, and whether the liver was split. A separate index (DLI1) looking at 1-year survival showed donor cardiac disease, black ethnicity, and steatosis to be additional risk factors. A strong association was found between DLI and whether or not a surgeon accepts an offered liver for transplant, with a marked fall in acceptance rates for livers with an index greater than 1.31. Since 2000, there has been a notable reduction in the quality of livers transplanted, coupled with variation between the 7 UK liver transplant centers in risk appetite.

Conclusions The DLI is an index of liver quality which enables analysis of the changing trends in liver quality and center behavior. DLI1 enables identification of factors affecting shorter-term survival, and perhaps identifies a cohort of livers that may benefit from novel preservation technologies.

Using data from the UK Transplant Registry, the authors develop a UK index of liver “quality” called the UK Donor Liver Index, which relates to the point of retrieval without reference to ischemic times, and estimates the risk of graft failure based on donor factors. Supplemental digital content is available in the text.

1 Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom.

2 Oxford Transplant Centre, Churchill Hospital, Oxford, United Kingdom.

3 University of Cambridge Department of Surgery, Addenbrooke’s Hospital, Cambridge, United Kingdom.

4 The National Institute for Health Research Blood and Transplant Research Unit (NIHR BTRU) in Organ Donation and Transplantation at the University of Cambridge, Cambridge, United Kingdom.

Received 21 July 2016. Revision received 6 October 2016.

Accepted 22 October 2016.

The research was funded by the National Institute for Health Research Blood and Transplant Research Unit (NIHR BTRU) in Organ Donation and Transplantation at the University of Cambridge in collaboration with Newcastle University and in partnership with NHS Blood and Transplant (NHSBT). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health or NHSBT.

The authors declare no conflicts of interest.

DC, PJF, and CJEW conceived of the study, contributed to the analysis and interpretation of the data, approved the final manuscript and agree to be accountable for all aspects of the work.

Correspondence: Christopher J.E. Watson, MD, Department of Surgery, Box 202, Addenbrooke’s Hospital, Cambridge CB2 0QQ, United Kingdom. (

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

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