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This study is a database analysis of all 5939 liver transplantations from deceased donors into adult recipients from the 1st of January 2003 until the 31st of December 2007 in Eurotransplant. Data were analyzed with Kaplan�CMeier and Cox regression models. From 5723 patients follow-up data were available with a mean of 2.5 years. After multivariate analysis the DRI (p http://www.selleckchem.com/products/jq1.html and possibly http://www.selleck.cn/products/AP24534.html for allocation purposes within the Eurotrans-plant region. The success of liver transplantation has led to broader indication for liver transplantation and although there has been increasing numbers of liver donors, the numbers of patients on the wait-list increased even faster (1). This resulted in an increased scarcity of liver allografts and the use of livers from extended criteria donors (ECDs) is being explored. However, there is no unambiguous definition of such an ECD. Within the Eurotransplant region an ECD is currently defined by the following general ECD criteria: tumor, drug abuse, sepsis, meningitis, hepatitis B or C. In addition a set of liver ECD criteria is being used: donor age greater than 65 years, intensive care unit (ICU) stay greater than 7 days, high BMI, steatosis, hypernatremia and high levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT) or bilirubin. If any of these parameters apply, a donor is considered an ECD (2). Such a bivalent score has little discriminative value and currently over 50% of liver allografts within the Eurotransplant region are considered extended. Except for donor age, none of the Eurotransplant liver-specific ECD criteria have been validated and a better definition of ECD is warranted. Several studies (3�C7) have been performed in order to predict outcome after liver transplantation by using risk models based on donor and transplant factors. Recently we validated the donor risk index (DRI), as conducted by Feng et al. (3), for use as a risk indicator within the Eurotransplant region and when comparing liver http://www.selleckchem.com/products/Rapamycin.html transplantation outcome data (8). An interesting finding was a remarkable difference in mean DRI between the Organ Procurement and Transplantation Network (OPTN) (mean DRI 1.45) and the Eurotransplant region (mean DRI 1.70). Reasons for this difference in mean DRI between OPTN and Eurotransplant were the differences in some DRI-factors, such as donor age, cause of death (COD), donation after cardiac death (DCD), split liver donation and allocation. The factor race is not registered in Eurotransplant and can therefore not be used.