Influence of postoperative complications on long-term survival in liver transplant patients

• 作者: Enrique Toledo Federico Castillo Juan Carlos Rodríguez-Sanjuán Juan Echeverri Roberto Fernández-Santiago Sonia Castanedo
• 来源期刊: 世界胃肠外科杂志:英文版(电子版)
• 学科: 医学
• 关键词: Liver transplant COMPLICATION SURVIVAL Comprehensive complication index Clavien PROGNOSIS
• 年，卷（期）: 2020,（8）
• 页码范围: 336-345
• 页数: 10页
• 分类号: R73

摘要

BACKGROUND Liver transplant(LT)is a complex procedure with frequent postoperative complications.In other surgical procedures such as gastrectomy,esophagectomy or resection of liver metastases,these complications are associated with poorer long-term survival.It is possible this happens in LT but there are not enough data to establish this relationship.AIM To analyze the possible influence of postoperative complications on long-term survival and the ability of the comprehensive complication index(CCI)to predict this.METHODS Retrospective study in a tertiary-level university hospital.The 164 participants were all patients who received a LT from January 2012 to July 2019.The follow-up was done in the hospital until the end of the study or death.Comorbidity and risk after transplantation were calculated using the Charlson and balance of risk(BAR)scores,respectively.Postoperative complications were graded according to the Clavien-Dindo classification and the CCI.To assess the CCI cut-off value with greater prognostic accuracy a receiver operating characteristic(ROC)curve was built,with calculation of the area under the curve(AUC).Overall survival was estimated according to the Kaplan-Meier test and log-rank test.Groups were compared by the Mann-Whitney test.For the multivariable analysis the Cox regression was used.RESULTS The mean follow-up time of the cohort was 37.76(SD=24.5)mo.A ROC curve of CCI with 5-year survival was built.The AUC was 0.826(0.730-0.922),P<0.001.The cut-off was calculated by means of the Youden index with a result of 35.95.The sensitivity was 84.6%and the specificity 61.3%.Survival curves for comparison of patients with CCI score<36 vs≥36 were calculated.The estimated 5-year survival was 57.65 and 43.95 months,respectively(log-rank<0.001).This suggests that patients with more severe complications exhibit worse long-term survival.Other cut-off values were analysed.Comparison between patients with CCI<33.5 vs>33.5(33.5=median CCI value)showed estimated 5-year survival was 57.4 and 45.71 months,re