Introduction: Intestinal and multi-visceral transplantation (IT & MVT) have been a standard procedure with a total of 2600 cases performed in the US and 3500 all over the world. Their recent outcome has improved over the last two decades. Donor selection is essential for successful IT & MVT. We tend to use a very selected group of donors such as young, hemodynamically stable donor for IT & MVT compared to donors for liver or kidney transplantation in current practice. Donor selection has been examined in liver and kidney transplantation. Donor Risk Index for liver (DRI) and kidney transplantation (KDPI) have been developed. However, there is not an index created for IT & MVT transplantation yet. This is the first study to comprehensively examine donor risk factors for IT & MVT with intention to make donor risk index formula in IT & MVT transplantation.

Methods: Retrospective data collection from UNOS database was used. Data from The United Network for Organ Sharing (UNOS) of 2,439 IT & MVT transplant patients between 1990 to 2014 were analyzed. IT & MVT transplant patients were categorized into three main types of visceral transplantation (I-intestine, II-liver-intestine, and III-multivisceral[III-1 full/ III-2 modified]). Cox regression was used to model the risk of death or graft loss, based on donor and transplant factors, adjusting for recipient factors. 

Results: Univariate and multivariate analysis were performed for patient and graft survival. Risk factors were chosen for donor risk index formula. Those were donor's race, weight, cause of death, total birilubin, GOT, recipient's birilubin, ICU status, albumin, type of transplant. We have developed IT & MVT donor risk index (IDRI) as figure 1. IDRI predict post transplantation graft survival (Kaplan-Meier) well as Figure 2.

Conclusions/ Discussions: IDRI predicts intestinal graft survival. IDRI can be used for risk-stratification when we select a donor for intestinal and multivisceral transplantation in an objective way. Possibly IDRI can be used for allocation algorithm for IT & MVT in the future.

UNOS/ OPTN.

[1] Feng S, Goodrich NP, Bragg-Gresham JL, Dykstra DM,Punch JD, DebRoy MA, et al. Characteristics associated with liver graft failure: the concept of a donor risk index.Am J Transplant 2006;6:783-790.