The benefit of liver transplantation is determined not only by the severity of illness, but also by the likelihood of posttransplantation survival.
Current models are unable to accurately predict which patients will have the best posttransplant survival.
|40% had 1 or more comorbidities prior to transplantation|
Dr Michael Volk and colleagues from Los Angeles, USA hypothesized that the Charlson Comorbidity Index, which includes 9 comorbidities, could be used to predict survival after liver transplantation.
The research team performed a retrospective study of 624 patients undergoing liver transplantation, with a median follow-up time of 4 years.
Data on pretransplant comorbidities were collected, along with potential confounders such as age, gender, etiology, and severity of liver disease.
Proportional hazards analysis was performed to determine the independent effect of each variable on posttransplantation survival.
The researchers recalibrated the Charlson Comorbidity Index for use in the liver transplant population.
The Charlson Comorbidity Index was recalibrated using a simplified weighting system to create the Charlson Comorbidity Index-orthotopic liver transplantation.
This improved the likelihood ratio chi-squared value from 15 to 24 for predicting posttransplantation survival.
The research team noted that a total of 40% of patients had 1 or more comorbidities prior to transplantation.
In the multivariate analysis, Charlson Comorbidity Index was an independent predictor of posttransplantation survival.
When the individual components of the Charlson Comorbidity Index were analyzed, the team found that coronary disease was an independent predictor of survival.
Diabetes, chronic obstructive pulmonary disease, connective tissue disease, and renal insufficiency were all independent predictors of posttransplant survival.
Dr Volk's team concluded, "Survival after liver transplantation is diminished in patients with pretransplantation coronary disease, diabetes, chronic obstructive pulmonary disease, connective tissue disease, and renal insufficiency."
"This study demonstrates the usefulness of a modified comorbidity index, the Charlson Comorbidity Index, for predicting posttransplantation survival."