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CCI for orthotopic LT did not predict mortality post-transplant

Researchers in Canada found that the Charlson Comorbidity Index for orthotopic liver transplantation did not predict mortality post-transplant in patients with cirrhosis, according to study data.

For this retrospective cohort study, researchers collected and analyzed data of 524 patients with cirrhosis who underwent orthotopic liver transplantation (OLT) between 2002 and 2012 at the University of Alberta Hospital. Of these patients, 68% were male, the median age was 54 years and 24% underwent OLT due to HCV. Other indications for transplant included liver malignancy (21%) and primary biliary cirrhosis or primary sclerosing cholangitis (18%).

Over the course of a median follow-up after OLT of 3.5 years, 117 patients died and 23 underwent re-transplant. From the survival analysis, overall survival rates after OLT were 89% at 1 year, 80% at 3 years and 73% at 5 years.

The results of this particular analysis showed that Charlson Comorbidity Index for OLT (CCI-OLT) was not associated with 5-year mortality as a continuous variable (P = .25) or categorical variable (P = .40).

To construct a new predictive model, researchers used the following six variables: age, BMI, HCV, hepatic encephalopathy, ICU stay at transplant and live donor.

“These six variables were deemed to be the best to derive the new predictive model of 5-year mortality after OLT,” according to the researchers.

Through the new model, age (P = .004), BMI (P = .008), hepatic encephalopathy (P = .032) and ICU stay (P = .037) were found to be predictors of 5-year mortality after OLT. The C-index of this new predictive model was 0.64, according to the study.

“Based on the six variables included in the new predictive model of 5-year predictive mortality after OLT, a nomogram to estimate individual predicted probability of 1-, 3- and 5-year survival after transplant was derived,” the researchers wrote. “Total points are calculated by adding points earned of the six predictive variables.”

The researchers concluded: “The relatively modest discriminative capacity of this [new] model suggests that pre-transplant characteristics may be of limited value in predicting post-transplant outcomes in such highly selected patients.” – by Melinda Stevens

Disclosures: Cardoso reports support for the study through an unrestricted educational grant from Gambro Inc. Please see the full study for a list of all other authors’ relevant financial disclosures.