Aim: To determine the impact of Charlson comorbidity index (CCI) on waiting list (WL) and post liver retransplantation (LRT) survival.
Methods: Comparative study of all adult patients assessed for primary liver transplant (PLT) ( = 1090) and patients assessed for LRT ( = 150), 2000-2007 at our centre. Demographic, clinical and laboratory variables were recorded.
Results: Median age for all patients was 53 years and 66% were men. Median model for end stage liver disease (MELD) score was 15. Median follow-up was 7-years. For retransplant patients, 84 (56%) had ≥ 1 comorbidity. The most common comorbidity was renal impairment in 66 (44.3%). WL mortality was higher in patients with ≥ 1 comorbidity (76% 53%, = 0.044). CCI (OR = 2.688, 95%CI: 1.222-5.912, = 0.014) was independently associated with WL mortality. Patients with MELD score ≥ 18 had inferior WL survival (Log-Rank 6.469, = 0.011). On multivariate analysis, CCI (OR = 2.823, 95%CI: 1.563-5101, = 0.001), MELD score ≥ 18 (OR 2.506, 95%CI: 1.044-6.018, = 0.04), and requirement for organ support prior to LRT ( < 0.05) were associated with reduced post-LRT survival. Donor/graft parameters were not associated with survival ( = NS). Post-LRT mortality progressively increased according to the number of transplanted grafts (Log-Rank 18.455, < 0.001). Post-LRT patient survival at 1-, 3- and 5-years were significantly inferior to those of PLT at 88% 73%, < 0.001, 81% 71%, = 0.018 and 69% 55%, = 0.006, respectively.
Conclusion: Comorbidity increases WL and post-LRT mortality. Patients with MELD ≥ 18 have increased WL mortality. Patients with comorbidity or MELD ≥ 18 may benefit from earlier LRT. LRT for ≥ 3 grafts may not represent appropriate use of donated grafts.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5534363 | PMC |
http://dx.doi.org/10.4254/wjh.v9.i20.884 | DOI Listing |
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