Use of AA donors allows consideration of older donors. (Hepatology 2013;58:1263–1269) Hepatitis C virus (HCV) is the leading indication for liver transplantation (LT) in the United States.[1] Compared to Caucasians, African-Americans (AA) have relatively superior outcomes with chronic HCV disease

prior to transplantation,[2, 3] but experience more aggressive recurrence of HCV disease after liver replacement.[4, 5] The 2-year and 5-year graft survival for HCV-positive AA LT recipients has been reported to be as much as 10% lower than in non-AA recipients.[6, 7] The reason for this disparity in outcome is poorly understood. A lower likelihood of responding to antiviral therapy post-LT may be one factor.[8, 9] Donor factors are likely to be of importance NVP-BKM120 also. The Donor Risk Index (DRI)—derived from 20,023 predominantly pre-Model for Endstage Liver Disease (MELD) era U.S. liver transplants—was originally proposed in 2006 to predict LT recipient outcome based on available donor factors. Containing seven donor variables, DRI predicts post-LT graft failure using a continuous, numerical scoring system.[10] The DRI was a milestone in highlighting the importance of donor quality on LT outcomes, and while the inclusion of a large, heterogeneous recipient pool maximized its generalizability, the DRI may have more limited prediction among specific find more subgroups, such as those

transplanted for HCV. Prior retrospective studies have shown a strong and consistent association between donor age and severity of HCV recurrence.[11, 12] Interestingly, in the original DRI, allografts from AA donors, compared to Caucasian donors, were associated with an medchemexpress increased risk (hazard ratio [HR] 1.19, 95% confidence interval [CI] 1.10-1.29, P < 0.001) of posttransplant graft failure (death or re-LT); but several recent studies of HCV-infected transplant recipients have independently demonstrated a trend of improved graft outcomes when AA donor livers were paired with HCV-positive AA recipients.[4, 13, 14] With these observations in mind, we sought to define the donor factors of importance in AA recipients with HCV and to develop a donor

risk model that accurately estimates risk of graft loss for this patient subgroup. With Institutional Review Board (IRB) approval, we examined adult AA recipients of deceased donor liver transplants from March 1, 2002 to December 31, 2009 (MELD-era) with primary, secondary, or other diagnosis of HCV recorded in the UNOS Standard Transplant Analysis and Research (STAR) file created on June 30, 2011. We excluded liver retransplants and recipients with Status 1, human immunodeficiency virus (HIV-coinfection, or less than 30 days of follow-up. The primary outcome was post-LT graft loss (recipient death or retransplant). Recipient and donor factors were described with frequency distributions and medians (interquartile ranges [IQRs]).