A Simplified Risk Assessment Tool to Predict Post Deceased Donor Liver Transplantation Outcomes: A Single, Highly Experienced Medical Center in Taiwan

Liver transplantation (LT) is the standard treatment for end-stage liver disease, yet the gap between the demand for organs and their availability is widening. In Taiwan, the scarcity of deceased donor organs highlights the need for optimized utilization strategies. The donor risk index (DRI) has emerged as a predictive tool for transplant outcomes, but existing models are not well-suited for Taiwan's unique demographic and clinical context. This retrospective cohort study analyzed a total of 118 deceased donor liver transplantation (DDLT) cases from Chang Gung Memorial Hospital between January 2020 and October 2023. Key demographic and clinical data were collected, focusing on one-year mortality and associated outcomes. Additionally, a retrospective validation cohort of 60 patients from January 2018 to December 2019 and a prospective validation cohort of 41 patients from November 2023 to August 2024 were included to assess the robustness of the CGMH-DRI model. Statistical analyses included univariate and multivariate logistic regression to identify independent risk factors. The study identified MELD 3.0 score, donor total bilirubin, and cold ischemia time (CIT) as independent predictors of one-year mortality. The CGMH-DRI model demonstrated good predictive performance (AUC = 0.778) for mortality, early allograft dysfunction (EAD), and major complications. Validation results showed consistent performance, with AUROC values of 0.716 in the retrospective cohort and 0.694 in the prospective cohort for one-year mortality; 0.781 and 0.676 for EAD; and 0.727 and 0.705 for major complications, respectively. The CGMH-DRI model offers a simple yet helpful tool for risk stratification in DDLT. It enables clinicians to identify high-risk patients and improve decision-making in liver transplantation. Further validation in diverse populations is warranted to enhance its applicability.