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Comorbidity Index as a Selection Tool for Living Donor Liver Transplantation in Elderly Patients
Altan Alim1, Eugen Malamutmann2, Murat Dayangac1
1Liver Transplantation Center, Florence Nightingale Hospital, Istanbul Bilim University, Istanbul, Turkey.
Insights
The Charlson Comorbidity Index (CCI) effectively predicts survival in elderly patients undergoing living donor liver transplantation (LDLT). A lower CCI indicates better outcomes, making it a valuable tool for patient selection in LDLT.
Area of Science:
- Hepatology
- Transplantation Surgery
- Geriatric Medicine
Background:
- Age alone is not a contraindication for living donor liver transplantation (LDLT).
- Careful patient selection is crucial to optimize outcomes in elderly LDLT recipients.
- The Charlson Comorbidity Index (CCI) may aid in risk stratification for this population.
Purpose of the Study:
- To evaluate the utility of the Charlson Comorbidity Index (CCI) for risk stratification in elderly patients undergoing living donor liver transplantation (LDLT).
- To identify predictive factors for survival in patients over 60 years old receiving LDLT.
Main Methods:
- Retrospective analysis of 951 LDLT recipients (October 2004 - February 2018).
- Identified 96 elderly recipients (>60 years) and assessed their CCI.
- Performed univariate and multivariate Cox regression analyses to determine survival predictors.
Main Results:
- Elderly LDLT recipients (n=96) had a median survival of 33 months (81.2% alive).
- Patients with a CCI > 4 had a survival of less than 12 months.
- Pulmonary disease, renal disease, and higher CCI were independent negative predictors of survival.
Conclusions:
- The Charlson Comorbidity Index (CCI) significantly influences survival in elderly LDLT patients.
- CCI can serve as a valuable criterion for selecting elderly candidates for living donor liver transplantation.
- Risk stratification using CCI can improve outcomes for older adults undergoing LDLT.
Background:
Previously published data have shown that age alone is not a contraindication for living donor liver transplantation (LDLT). However, careful evaluation is needed to identify the patients who are unlikely to benefit from LDLT. We hypothesized that the Charlson Comorbidity Index (CCI) could be used as one of the criteria for risk stratification in elderly patients undergoing LDLT.
Patients And Methods:
There were 951 patients who underwent LDLT between October 2004 and February 2018. All recipients who were older than 60 years of age at the time of transplantation were identified. The comorbidity score was retrospectively assessed for each elderly patient according to the Charlson Comorbidity Index. Univariate and multivariate Cox regression analyses were performed to identify independent predictive factors for survival in elderly patients after LDLT.
Results:
There were 96 patients (10.1%) in the age of > 60 years. All patients received the right lobe of their donor. Out of these patients, 18 (18.7%) died in the median time of 4 months. The remaining 78 patients (81.2%) are alive, with a median survival of 33 months. The CCI of these patients was significantly lower compared to the other 18 patients (2 versus 4). None of the patients with a CCI above 4 survived longer than 12 months. The results of the multivariate Cox regression analyses have shown that pulmonary disease, renal disease, and CCI are independent negative predictive factors for survival.
Conclusion:
The results of our study show clearly that the CCI has a significant influence on survival after LDLT in elderly patients and can be used as one of the selection criteria for LDLT in elderly patients.
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