Ann Surg Treat Res.  2023 Jun;104(6):358-363. 10.4174/astr.2023.104.6.358.

Modified Charlson comorbidity index as a survival prediction tool for older patients after liver transplantation

• Choi J
• Choi EW
• Choi Y
• Hong Sy
• Suh S
• Hong K
• Han ES
• Lee Jm
• Hong SK
• Yi NJ
• Lee KW
• Suh KS

• KMID: 2542800
• DOI: http://doi.org/10.4174/astr.2023.104.6.358

Abstract

Purpose
An increasing number of older patients now undergo liver transplantation (LT). Although the overall outcomes in older patients are not different from those of younger patients, there is no tool to predict LT prognosis in older patients. We hypothesized that a modified Charlson comorbidity index (mCCI) and 5-factor modified frailty index (mFI-5) can predict outcomes in older patients after LT.
Methods
This retrospective study included 155 patients (aged >65 years) who underwent LT at Seoul National University Hospital. The recipients were subcategorized into 2 groups based on the mCCI score and mFI-5: the low (0–1) and high (2–5) mCCI groups, and low (≤0.4) and high (>0.4) mFI-5 groups. The independent effect of each variable on post-LT survival was determined using the mCCI subgroup, age at transplantation, sex, Child-Turcotte-Pugh score, model for end-stage liver disease (MELD) score, and mFI-5 subgroup.
Results
The high-mCCI group (41 patients) showed significantly lower 1- and 3-month and 1-, 3-, and 5-year survival than the low-mCCI group. Using the Cox regression model, the mCCI, sex, and MELD score remained significant. The mFI-5 was not a significant factor to predict patients’ survival.
Conclusion
The mCCI and MELD scores could be used to predict post-LT survival in older patients.

Keyword

Acute liver failure; End stage liver disease; Hepatocellular carcinoma; Immunosuppression; Patient care