Comorbidities have a limited impact on post-transplant survival in carefully selected cirrhotic patients: a population-based cohort study

Annals of Hepatology

Constantine J. Kanvellas, MD, SM,¹  Sean M. Bagshaw¹  Pedro Fidalgo¹  Filipe S. Cardoso¹  Juan G. Abraldes²  Norman M. Kneteman³  Glenda Meeberg⁴ 

[1] Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada;Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada;Division of Transplantation, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada;Liver Transplant Program, Alberta Health Services, Edmonton, Alberta, Canada;

关键词: Cirrhosis;    Transplant;    Risk prediction;    Long-term survival;    Nomogram;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background. Improving estimation of long-term survival of patients with end-stage liver disease after orthotopic liver transplantation (OLT) would optimize decisions on eligibility for transplant. We aimed to externally validate previously derived Charlson Comorbity Index for OLT (CCI-OLT); subsequently, we developed a new model to predict 5-year mortality after transplant.Material and methods. This single center retrospective cohort study included 524 consecutive adult cirrhotic patients who underwent OLT in 2002-2012. External validation of CCI-OLT used Kaplan-Meier method. Derivation of the new predictive model used Cox proportional hazards regression.Results. One-, 3-, and 5-year cumulative survival after OLT was 89%, 80%, and 73%, respectively. CCI-OLT was not associated with 5-year mortality after transplant (P = 0.34). We derived and internally validated a new predictive model of 5-year mortality after OLT based on six pre-transplant characteristics of patients: age, body mass index, hepatitis C, hepatic encephalopathy, intensive care unit stay at transplant, and live donor (C-index = 0.64). We further developed a nomogram to estimate individual probability of 1-, 3-, and 5-year survival after OLT.Conclusions. In our cohort, CCI-OLT was not associated with survival following transplant. The new predictive model discriminative capacity was only modest, suggesting that pre-transplant characteristics are of limited value in predicting post-transplant outcomes in thoroughly selected patients.

【 授权许可】

Unknown