Supplementary Material for: The Impact of Donor Risk Index, Recipients’ and Operative Characteristics on Post Liver Transplant One-Year Graft Failure: A Cohort Analysis

Background and Aims: The donor risk index (DRI) quantifies donor-related characteristics potentially associated with increased risk of early graft failure. We aimed to assess the impact of the DRI, recipient and perioperative factors on post liver transplant (LT) outcomes. Methods: This was a single-center retrospective cohort study including all adult (≥18 years) patients who underwent LT from 01/2019 to 12/2019 at Curry Cabral Hospital, Lisbon, Portugal. Primary endpoint was 1-year graft failure post LT. Associations were studied with logistic regression. Results: A total of 131 cadaveric donor LT procedures were performed in 116 recipients. Recipients’ median (IQR) age was 57 (47–64) years and 101/131 (77.1%) were males. Cirrhosis was the underlying etiology in 95/131 (81.2%) transplants. Based on 8 predefined donors’ characteristics, median (IQR) DRI was 1.96 (1.67–2.16). Following adjustment for MELDNa score pre LT and SOFA score (adjusted odds ratio [aOR], 95% confidence interval [CI] = 0.91 [0.56–1.47]) or lactate (aOR [95% CI] = 2.76 [0.71–10.7]) upon intensive care unit (ICU) admission post LT, DRI was not associated with 1-year graft failure. However, higher SOFA score (aOR [95% CI] = 1.20 [1.05–1.37]) or lactate (aOR [95% CI] = 1.27 [1.10–1.46]) upon ICU admission post LT were independently associated with higher odds of 1-year graft failure. Conclusions: In a recent cohort of patients who underwent LT, DRI, despite being high, was not associated with 1-year graft failure, but SOFA score or lactate upon ICU admission post LT were.背景与目的：供体风险指数（Donor Risk Index, DRI）可量化与移植早期移植物失败风险升高潜在相关的供体相关特征。本研究旨在评估供体风险指数、受体及围手术期因素对肝移植（Liver Transplant, LT）术后结局的影响。 方法：本研究为单中心回顾性队列研究，纳入2019年1月至2019年12月期间，在葡萄牙里斯本库里·卡布拉尔医院接受肝移植的所有成年（≥18岁）患者。主要终点为肝移植术后1年移植物失败。采用logistic回归分析相关关联。 结果：本研究共完成131例尸体供体肝移植手术，涉及116名受体。受体的中位年龄（四分位间距，IQR）为57（47~64）岁，其中男性101例（占比77.1%）。95例（81.2%）移植的基础病因为肝硬化。基于8项预设供体特征计算得出的中位供体风险指数为1.96（1.67~2.16）。在校正肝移植术前终末期肝病模型钠评分（Model for End-Stage Liver Disease-Na, MELDNa）及肝移植术后重症监护病房（Intensive Care Unit, ICU）入院时的序贯器官衰竭评分（Sequential Organ Failure Assessment, SOFA）（校正比值比[adjusted odds ratio, aOR]，95%置信区间[confidence interval, CI] = 0.91 [0.56~1.47]）或血乳酸水平（aOR [95% CI] = 2.76 [0.71~10.7]）后，供体风险指数与术后1年移植物失败无显著关联。然而，肝移植术后重症监护病房入院时较高的序贯器官衰竭评分（aOR [95% CI] = 1.20 [1.05~1.37]）或血乳酸水平（aOR [95% CI] = 1.27 [1.10~1.46]）与术后1年移植物失败的更高比值比独立相关。 结论：在本近期纳入的肝移植患者队列中，尽管供体风险指数处于较高水平，但与术后1年移植物失败无显著关联；而肝移植术后重症监护病房入院时的序贯器官衰竭评分及血乳酸水平则与术后1年移植物失败显著相关。