Cargando…

Impact of comorbidity on waiting list and post-transplant outcomes in patients undergoing liver retransplantation

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) (n = 1090) and patients assessed for LRT (n = 150), 2000-2007 at our cen...

Descripción completa

Detalles Bibliográficos
Autores principales: Al-Freah, Mohammad A B, Moran, Carl, Foxton, Matthew R, Agarwal, Kosh, Wendon, Julia A, Heaton, Nigel D, Heneghan, Michael A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5534363/
https://www.ncbi.nlm.nih.gov/pubmed/28804571
http://dx.doi.org/10.4254/wjh.v9.i20.884
_version_ 1783253756869083136
author Al-Freah, Mohammad A B
Moran, Carl
Foxton, Matthew R
Agarwal, Kosh
Wendon, Julia A
Heaton, Nigel D
Heneghan, Michael A
author_facet Al-Freah, Mohammad A B
Moran, Carl
Foxton, Matthew R
Agarwal, Kosh
Wendon, Julia A
Heaton, Nigel D
Heneghan, Michael A
author_sort Al-Freah, Mohammad A B
collection PubMed
description 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) (n = 1090) and patients assessed for LRT (n = 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% vs 53%, P = 0.044). CCI (OR = 2.688, 95%CI: 1.222-5.912, P = 0.014) was independently associated with WL mortality. Patients with MELD score ≥ 18 had inferior WL survival (Log-Rank 6.469, P = 0.011). On multivariate analysis, CCI (OR = 2.823, 95%CI: 1.563-5101, P = 0.001), MELD score ≥ 18 (OR 2.506, 95%CI: 1.044-6.018, P = 0.04), and requirement for organ support prior to LRT (P < 0.05) were associated with reduced post-LRT survival. Donor/graft parameters were not associated with survival (P = NS). Post-LRT mortality progressively increased according to the number of transplanted grafts (Log-Rank 18.455, P < 0.001). Post-LRT patient survival at 1-, 3- and 5-years were significantly inferior to those of PLT at 88% vs 73%, P < 0.001, 81% vs 71%, P = 0.018 and 69% vs 55%, P = 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.
format Online
Article
Text
id pubmed-5534363
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Baishideng Publishing Group Inc
record_format MEDLINE/PubMed
spelling pubmed-55343632017-08-11 Impact of comorbidity on waiting list and post-transplant outcomes in patients undergoing liver retransplantation Al-Freah, Mohammad A B Moran, Carl Foxton, Matthew R Agarwal, Kosh Wendon, Julia A Heaton, Nigel D Heneghan, Michael A World J Hepatol Retrospective Cohort Study 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) (n = 1090) and patients assessed for LRT (n = 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% vs 53%, P = 0.044). CCI (OR = 2.688, 95%CI: 1.222-5.912, P = 0.014) was independently associated with WL mortality. Patients with MELD score ≥ 18 had inferior WL survival (Log-Rank 6.469, P = 0.011). On multivariate analysis, CCI (OR = 2.823, 95%CI: 1.563-5101, P = 0.001), MELD score ≥ 18 (OR 2.506, 95%CI: 1.044-6.018, P = 0.04), and requirement for organ support prior to LRT (P < 0.05) were associated with reduced post-LRT survival. Donor/graft parameters were not associated with survival (P = NS). Post-LRT mortality progressively increased according to the number of transplanted grafts (Log-Rank 18.455, P < 0.001). Post-LRT patient survival at 1-, 3- and 5-years were significantly inferior to those of PLT at 88% vs 73%, P < 0.001, 81% vs 71%, P = 0.018 and 69% vs 55%, P = 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. Baishideng Publishing Group Inc 2017-07-18 2017-07-18 /pmc/articles/PMC5534363/ /pubmed/28804571 http://dx.doi.org/10.4254/wjh.v9.i20.884 Text en ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Retrospective Cohort Study
Al-Freah, Mohammad A B
Moran, Carl
Foxton, Matthew R
Agarwal, Kosh
Wendon, Julia A
Heaton, Nigel D
Heneghan, Michael A
Impact of comorbidity on waiting list and post-transplant outcomes in patients undergoing liver retransplantation
title Impact of comorbidity on waiting list and post-transplant outcomes in patients undergoing liver retransplantation
title_full Impact of comorbidity on waiting list and post-transplant outcomes in patients undergoing liver retransplantation
title_fullStr Impact of comorbidity on waiting list and post-transplant outcomes in patients undergoing liver retransplantation
title_full_unstemmed Impact of comorbidity on waiting list and post-transplant outcomes in patients undergoing liver retransplantation
title_short Impact of comorbidity on waiting list and post-transplant outcomes in patients undergoing liver retransplantation
title_sort impact of comorbidity on waiting list and post-transplant outcomes in patients undergoing liver retransplantation
topic Retrospective Cohort Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5534363/
https://www.ncbi.nlm.nih.gov/pubmed/28804571
http://dx.doi.org/10.4254/wjh.v9.i20.884
work_keys_str_mv AT alfreahmohammadab impactofcomorbidityonwaitinglistandposttransplantoutcomesinpatientsundergoingliverretransplantation
AT morancarl impactofcomorbidityonwaitinglistandposttransplantoutcomesinpatientsundergoingliverretransplantation
AT foxtonmatthewr impactofcomorbidityonwaitinglistandposttransplantoutcomesinpatientsundergoingliverretransplantation
AT agarwalkosh impactofcomorbidityonwaitinglistandposttransplantoutcomesinpatientsundergoingliverretransplantation
AT wendonjuliaa impactofcomorbidityonwaitinglistandposttransplantoutcomesinpatientsundergoingliverretransplantation
AT heatonnigeld impactofcomorbidityonwaitinglistandposttransplantoutcomesinpatientsundergoingliverretransplantation
AT heneghanmichaela impactofcomorbidityonwaitinglistandposttransplantoutcomesinpatientsundergoingliverretransplantation