Modified Charlson Comorbidity Index for predicting survival after liver transplantation

Abstract

The benefit of liver transplantation (LT) 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. We hypothesized that the Charlson Comorbidity Index (CCI), which includes nine comorbidities, could be used to predict survival after LT. We performed a retrospective study of 624 patients undergoing LT, with a median follow-up time of 4.3 yr. 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, and to recalibrate the CCI for use in the liver transplant population. A total of 40% of patients had 1 or more comorbidities prior to transplantation. In the multivariate analysis, CCI was an independent predictor of posttransplantation survival (hazard ratio [HR] 1.21 per unit, P Ͻ 0.001). When the individual components of the CCI were analyzed, coronary disease (HR 2.33), diabetes (HR 1.38), chronic obstructive pulmonary disease (COPD) (HR 2.67), connective tissue disease (HR 2.32), and renal insufficiency (HR 1.61) were all independent predictors of posttransplant survival. The CCI was recalibrated using a simplified weighting system to create the CCI-orthotopic LT (OLT), which improved the likelihood ratio chi-squared value from 15 to 24 for predicting posttransplantation survival. In conclusion, survival after LT is diminished in patients with pretransplantation coronary disease, diabetes, COPD, connective tissue disease, and renal insufficiency. We demonstrate the usefulness of a modified comorbidity index, the CCI-OLT, for predicting posttransplantation survival. Liver Transpl 13:1515Transpl 13: -1520Transpl 13: , 2007

The use of perioperative serial blood lactate levels, the APACHE II and the postoperative MELD as predictors of early mortality after liver transplantation

“…In this particular task, a number of attempts using different approaches to explore this matter were undertaken. Volk et al 8 verified that the Charlson comorbidity index can be applied for prediction of mortality after liver transplantation, because the …”

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“…The patient's age and comorbidities also promote the susceptibility to infection, and contribute to an impaired immune response. 7,8 Although elderly patients who undergo a liver transplant do not show higher complication rates compared with younger patients, 9 they require more transfusions and fluids during the liver transplant and show reduced renal function. Also, the presence of comorbidities (ie, chronic obstructive pulmonary disease, renal failure), especially when correlated with alcoholic hepatopathy, affected their outcome.…”

“…Also, the presence of comorbidities (ie, chronic obstructive pulmonary disease, renal failure), especially when correlated with alcoholic hepatopathy, affected their outcome. 7,8 Nonetheless, these factors have been analyzed less as determinants of outcome among liver transplant recipients who develop posttransplant infections, and their effect is underestimated.…”

MELD score measured day 10 after orthotopic liver transplantation predicts death and re-transplantation within the first year

“…Pre-transplant prognostic scores to predict post-transplant mortality have been developed, but the only score of clinical value is the Charles comorbidity index (21)(22)(23). Early post-transplant prognostic scores are of greater value, and several has previously been evaluated (12,13,(15)(16)(17).…”