Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 18, 2017; 9(20): 884-895
Published online Jul 18, 2017. doi: 10.4254/wjh.v9.i20.884
Impact of comorbidity on waiting list and post-transplant outcomes in patients undergoing liver retransplantation
Mohammad A B Al-Freah, Carl Moran, Matthew R Foxton, Kosh Agarwal, Julia A Wendon, Nigel D Heaton, Michael A Heneghan
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 Hospital, London SE5 9RS, United Kingdom
Author contributions: All authors contributed to this paper.
Institutional review board statement: Ethical approval for interrogation, analysis and publication of this anonymised dataset was given by the Southeast London Research Ethics Committee 3 (previously known as King’s College Hospital Research Ethics Committee).
Informed consent statement: All patients’ details in the dataset for this paper were anonymised. Patients consent was not deemed necessary by the Southeast London Research Ethics Committee 3 (previously known as King’s College Hospital Research Ethics Committee) giving the retrospective design of the study.
Conflict-of-interest statement: No conflicts of interest relevant to this article were reported. Michael A Heneghan is supported by an educational grant from The Kelly Group.
Data sharing statement: Anonymised dataset will be made available on request from Mohammad Al-Freah at alfreah@yahoo.com.
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/
Correspondence to: Dr. Michael A Heneghan, Consultant Hepatologist, Institute of Liver Studies, King’s College Hospital, Denmark Hill, London SE5 9RS, United Kingdom. michael.heneghan@nhs.net
Telephone: +44-203-2991661 Fax: +44-203-2993167
Received: November 4, 2016
Peer-review started: November 8, 2016
First decision: November 30, 2016
Revised: May 12, 2017
Accepted: May 30, 2017
Article in press: May 31, 2017
Published online: July 18, 2017
Abstract
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.

Keywords: Hepatic, Organ, Outcome, Diabetes, Renal

Core tip: The prevalence and impact of comorbidity on waiting list (WL) and post-transplant survival is unknown in patients who had liver retransplantation. This study identified comorbidity(ies) were common (56%) in this cohort, most with renal impairment. WL mortality was higher in patients with ≥ 1 comorbidity and model for end stage liver disease (MELD) score ≥ 18. Post-transplant survival was inferior in patients with ≥ 1 comorbidity, MELD score ≥ 18 and in patients who required organ support prior to retransplantation. Comorbidity increases WL and post-transplant mortality. Patients with comorbidity or MELD ≥ 18 may benefit from earlier retransplantation.