Refining the Liver Donor Risk Index with Machine Perfusion: A Bayesian Approach.

IF 3 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinical and Translational Gastroenterology Pub Date : 2025-09-29 DOI:10.14309/ctg.0000000000000921

Tomohiro Tanaka, Daniel Sewell

引用次数: 0

Abstract

Background: The Donor Risk Index (DRI) is a widely used liver transplant allograft risk model but does not account for the increasing adoption of Machine Perfusion (MP).

Methods: Using Bayesian updating, we incorporated MP into the DRI framework (DRI-MP). A Bayesian proportional hazards model with informative priors derived from the original DRI was applied to OPTN data from January 2022 to June 2024. Model performance was assessed using Harrell's Concordance (C)-statistic, calibration plots, and Brier scores.

Results: DRI-MP, defined as DRI × 0.7 for MP cases, improved 90-day graft survival discrimination (Harrell's C-statistic: = 0.546 vs. 0.535, p = 0.040), while maintaining robust calibration.

Conclusion: The Bayesian-updated DRI-MP modestly improves donor risk discrimination, reflecting contemporary transplant practice and providing an implementable tool with continuity from the original DRI.

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用机器灌注改进肝供者风险指数：贝叶斯方法。

背景：供体风险指数（DRI）是一种广泛使用的同种异体肝移植风险模型，但没有考虑到机器灌注（MP）的日益普及。方法：采用贝叶斯更新方法，将MP纳入DRI框架（DRI-MP）。将基于原始DRI的贝叶斯比例风险模型应用于2022年1月至2024年6月的OPTN数据。采用Harrell’s Concordance (C)统计量、校准图和Brier评分来评估模型的性能。结果：DRI-MP，定义为MP病例的DRI × 0.7，改善了90天移植物存活辨别（Harrell's c -统计量：= 0.546 vs. 0.535, p = 0.040），同时保持稳健校准。结论：贝叶斯更新的DRI- mp适度改善了供体风险歧视，反映了当代移植实践，并提供了一种可实施的工具，与原始DRI保持连续性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical and Translational Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

7.00

自引率

0.00%

发文量

114

审稿时长

16 weeks

期刊介绍： Clinical and Translational Gastroenterology (CTG), published on behalf of the American College of Gastroenterology (ACG), is a peer-reviewed open access online journal dedicated to innovative clinical work in the field of gastroenterology and hepatology. CTG hopes to fulfill an unmet need for clinicians and scientists by welcoming novel cohort studies, early-phase clinical trials, qualitative and quantitative epidemiologic research, hypothesis-generating research, studies of novel mechanisms and methodologies including public health interventions, and integration of approaches across organs and disciplines. CTG also welcomes hypothesis-generating small studies, methods papers, and translational research with clear applications to human physiology or disease. Colon and small bowel Endoscopy and novel diagnostics Esophagus Functional GI disorders Immunology of the GI tract Microbiology of the GI tract Inflammatory bowel disease Pancreas and biliary tract Liver Pathology Pediatrics Preventative medicine Nutrition/obesity Stomach.