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

World Journal of Hepatology 2017年第20期9卷 884-895页

作者： mohammad a b al-freah Carl Moran Matthew R Foxton Kosh Agarwal Julia A Wendon Nigel D Heaton Michael A Heneghan Institute of Liver Studies King’s College HospitalLondon SE5 9RSUnited Kingdom

AIM To determine the impact of Charlson comorbidity index(CCI) on waiting list(WL) and post liver retransplantation(LRT) *** 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(LogRank 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 al. 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 al at 1-, 3- and 5-years were significantly inferior to those of PLT at 88% vs 73%, P bidity 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.

关键词： Hepatic Organ Outcome Diabetes Renal

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