App to reality: snapshot validation of the US Pancreas Donor Risk Index in a UK center.
Mittal S., Sharples E., Lee F., Reddy S., Sinha S., Friend P., Vaidya A.
BACKGROUND: A pancreas donor risk index (PDRI) has been derived by Axelrod et al. to inform organ acceptance and developed into a smartphone app by Marc Melcher. This paper aims to validate the app for use in a single UK transplant center through a snapshot of donors and outcomes during one calendar year. METHODS: Donor details for all pancreas transplants performed in 2011 were collected from a prospectively maintained clinical database to calculate a PDRI using the Pancreas Transplant Donor Risk Index smartphone app. RESULTS: Ninety pancreas transplants were included in the analysis (72 simultaneous pancreas kidney [SPK], 18 pancreas transplant alone [PTA]). PDRI scores were found to be positively skewed compared with donors described in the US literature. The PDRI was predictive of poorer 1-y graft outcome in the SPK group but not in the PTA group. PDRI was not predictive of time to failure or failure cause. CONCLUSION: Validation of the PDRI app against data from our center shows that it can be used as a tool to predict poorer graft outcome in the SPK group. However, it was not predictive in the PTA group, and differences in US and UK donor characteristics were evident. Development of a UK-specific PDRI may overcome these limitations.