Lung Donor Risk Index (LDRI) Calculator

The Lung Donor Risk Index (LDRI) Calculator estimates the risk of graft failure in adult lung transplant recipients using donor and transplant factors derived from a Cox regression model.

Key Features:

• Donor/Transplant Factor Integration: The model incorporates 12 independently predictive factors: donor age, race, insulin-dependent diabetes, the difference between donor and recipient height, smoking, cocaine use, cytomegalovirus seropositivity, creatinine, human leukocyte antigen (HLA) mismatch, ischemia time, and donation after circulatory death.
• Risk Discrimination: Validation demonstrated reasonable graft failure risk discrimination with a C-statistic of 0.61, exceeding that of preceding donor risk metrics.
• Granular Risk Assessment: The index provides a detailed, factor-rich approach to donor lung quality evaluation compared to existing metrics.

Scientific Applications:

• Donor Lung Offer Evaluation: Transplant centers and organ procurement organizations can assess prospective donor lung quality and associated graft failure risk to inform organ acceptance decisions.
• Regulatory and Policy Analysis: Regulatory agencies can apply the LDRI for benchmarking, outcome monitoring, and policy development related to lung transplantation.
• Patient Decision-Making: The risk metric supports informed consent and shared decision-making by quantifying donor-specific graft failure risk for transplant candidates.

Methodology:

The LDRI was developed using Cox regression to model graft failure (defined as the earliest of death or retransplant) based on donor and transplant factors, with adjustment for recipient factors, using data from 26,549 adult lung transplant recipients in the United Network for Organ Sharing Standard Transplant Analysis and Research file. The index was derived and validated within this dataset.