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Donor risk index for African American liver transplant recipients with hepatitis C virus

African American (AA) liver transplant (LT) recipients with hepatitis C virus (HCV) have higher rates of graft loss than other racial/ethnic groups. The Donor Risk Index (DRI) predicts graft loss but is neither race‐ nor disease‐specific and may not be optimal for assessing donor risk for AA HCV‐positive LT recipients. We developed a DRI for AA with HCV with the goal of enhancing graft loss predictions. All U.S. HCV‐positive adult AA first deceased donor LTs surviving ≥30 days from March 2002 to December 2009 were included. A total of 1,766 AA LT recipients were followed for median 2.8 (interquartile range [IQR] 1.3‐4.9) years. Independent predictors of graft loss were donor age (40‐49 years: hazard ratio [HR] 1.54; 50‐59 years: HR 1.80; 60+ years: HR 2.34, P < 0.001), non‐AA donor (HR 1.66, P < 0.001), and cold ischemia time (CIT) (HR 1.03 per hour >8 hours, P = 0.03). Importantly, the negative effect of increasing donor age on graft and patient survival among AAs was attenuated by receipt of an AA donor. A new donor risk model for AA (AADRI‐C) consisting of donor age, race, and CIT yielded 1‐year, 3‐year, and 5‐year predicted graft survival rates of 91%, 77%, and 68% for AADRI <1.60; 86%, 67%, and 55% for AADRI 1.60‐2.44; and 78%, 53%, and 39% for AADRI >2.44. In the validation dataset, AADRI‐C correctly reclassified 27% of patients (net reclassification improvement P = 0.04) compared to the original DRI. Conclusion: AADRI‐C identifies grafts at higher risk of failure and this information is useful for risk‐benefit discussions with recipients. Use of AA donors allows consideration of older donors. (Hepatology 2013;58:1263–1269)