Developing and validation of a liver transplantation donation after cardiac death risk index using the UNOS database

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Conference Proceeding

Publication Date


Publication Title

Am J Transplant


Introduction: Donation after cardiac death (DCD) liver transplantation is an increasing form of organ donation. Shlegal et. al. identified seven factors predicting 1-year DCD graft survival based on the UK transplantation population. This project aims to validate the existing predictive model and to develop a novel DCD graft failure prediction model based on the UNOS database.

Methods: We examined all adult DCD transplanted Jan 1 2014 to Mar 31 2020 in the UNOS registry. The population was divided into train (66%) and validation (34%) subsets. Variables of interest were selected from the train subset with backwards stepwise selection with criteria for entry P = 0.05 and exit P = 0.06. Logistic regression models were fitted based on selected variables to predict 1-year graft failure. Performance of the model was assessed in the validation population by computing the area under the receiver operating characteristic curve (AUROC) after 10-fold stratified cross-validation. The performance of the novel model was compared to the UK DCD prediction model.

Results: 2738 DCD transplants were included in this study with 1835 in the train and 903 in the validation subsets. The model identified 12 factors predictive for 1-year graft failure among DCD recipients. The model AUROC was 0.741 (95% CI: 0.686, 0.796). When validating the UK DCD model in the UNOS database, the model achieved AUROC of 0.628 (0.564, 0.691).

Conclusions: This model identified 12 predictive factors predictive of 1-year graft failure among DCD recipients from the UNOS database, which outperformed the existing model.




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