Development and Validation of a Liver Graft Discard Score in Deceased Donor LT

Overview

This multicenter Italian study developed and validated a predictive scoring system for liver graft discard in deceased donors after brain death (DBD). The score effectively identified grafts at risk of liver-related discard and predicted biopsy features and 3-month graft loss, outperforming existing indices.

Background

Liver transplantation is the definitive treatment for many end-stage liver diseases, but graft availability remains limited. Optimizing donor liver selection is critical to increase transplant numbers and reduce waitlist mortality. Prior research has focused on post-transplant graft dysfunction, while pre-procurement predictors of graft quality are less established. This study aimed to create a reliable score to predict liver graft discard risk before procurement, guiding safer graft utilization.

Data Highlights

Key Findings

• A liver graft discard score was developed using 31 donor variables analyzed via cause-specific logistic regression.
• The score predicted liver-related graft discard with higher accuracy than donor age, BMI, and the Discard Risk Index (DSRI).
• Validation showed good sensitivity, specificity, and diagnostic odds ratio for identifying grafts at risk of discard.
• The score also predicted biopsy findings such as macrovesicular steatosis >30%, fibrosis, and necrosis.
• Higher discard score values correlated with increased risk of graft loss at 3 months post-transplant.
• The study controlled for center-related biases by including only grafts declined both locally and nationally.

Clinical Implications

The liver graft discard score provides transplant teams with a validated tool to assess graft suitability before procurement, potentially increasing safe graft utilization. By identifying high-risk grafts early, clinicians can better allocate resources and reduce recipient complications. This score may help standardize discard decisions across centers, improving organ allocation efficiency.

Conclusion

This multicenter study successfully developed and validated a liver graft discard scoring system that predicts liver-related discard and early graft outcomes. Implementation of this tool could optimize donor liver selection and enhance transplant success rates.

References

1. Italian Multicenter Study Group 2024 -- Development and assessment of a liver graft discard scoring system for deceased donor liver transplantation