Comorbidities have a limited impact on post-transplant survival in carefully selected cirrhotic patients: a population-based cohort study
Journal Title: Annals of Hepatology - Year 2015, Vol 14, Issue 4
Abstract
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.
Authors and Affiliations
Filipe S. Cardoso, Sean M. Bagshaw, Juan G. Abraldes, Norman M. Kneteman, Glenda Meeberg, Pedro Fidalgo, Constantine J. Karvellas
Keywords
Related Articles
- EP ID EP78476
- DOI -
- Views 124
- Downloads 0
Validation and comparison of simple noninvasive models for the prediction of liver fibrosis in chronic hepatitis C
Introduction. Although it is standard procedure in the evaluation of liver diseases, biopsy is an invasive method subject to sampling error and intra or inter-observer variability. Thus, surrogate markers of liver fibros...
Levocetirizine induced hepatotoxicity in a patient with chronic urticaria
Hepatitis A vaccination in healthcare personnel
Background and aims. Despite effective vaccine available, hepatitis A remains a significant cause of morbidity and mortality worldwide including acute liver failure, transplantation and death. Vaccination rates for hepat...
Unexpected discovery of massive liver echinococcosis. A clinical, morphological, and functional diagnosis
We report a case of symptomatic massive liver echinococcosis due to Echinococcus granulosus, unexpectedly found in a 34 year old woman living in Apulia, Italy. Based on size (max diameter 18 cm), clinical presentation, g...
Transforming growth factor ααααα immunoreactivity. A study in hepatocellular carcinoma and in non-neoplastic liver tissue
Background. Transforming growth factor alpha (TGFα) is an important mitogen that binds to epidermal growth factor receptor and is associated with the development of several tumors. Aims. Assessment of the immunoexpressi...