The role of the comprehensive complication index for the prediction of survival after liver transplantation

• DOI: 10.1007/s13304-020-00878-4
• Publication Date: 2020-09-06T14:02:30Z
• Authors: Quirino Lai; Fabio Melandro; Greg Nowak; Daniele Nicolini; Samuele Iesari; Elisa Fasolo; Gianluca Mennini; Antonio Romano; Federico Mocchegiani; Kevin Ackenine; Marina Polacco; Laura Marinelli; Olga Ciccarelli; Giacomo Zanus; Marco Vivarelli; Umberto Cillo; Massimo Rossi; Bo-Göran Ericzon; Jan Lerut
• Keywords: Adult; Graft Rejection; Male; Allograft dysfunction; Graft survival; MELD; Retransplantation; Survival prediction; Survival prediction; Time Factors; Allograft dysfunction; Graft Survival; Graft survival; Middle Aged; MELD; Liver Transplantation; 3. Good health; End Stage Liver Disease; 03 medical and health sciences; 0302 clinical medicine; Predictive Value of Tests; Research Design; Humans; Original Article; Female; Primary Graft Dysfunction; Retransplantation

AbstractIn the last years, several scoring systems based on pre- and post-transplant parameters have been developed to predict early post-LT graft function. However, some of them showed poor diagnostic abilities. This study aims to evaluate the role of the comprehensive complication index (CCI) as a useful scoring system for accurately predicting 90-day and 1-year graft loss after liver transplantation. A training set (n = 1262) and a validation set (n = 520) were obtained. The study was registered at https://www.ClinicalTrials.gov (ID: NCT03723317). CCI exhibited the best diagnostic performance for 90 days in the training (AUC = 0.94; p < 0.001) and Validation Sets (AUC = 0.77; p < 0.001) when compared to the BAR, D-MELD, MELD, and EAD scores. The cut-off value of 47.3 (third quartile) showed a diagnostic odds ratio of 48.3 and 7.0 in the two sets, respectively. As for 1-year graft loss, CCI showed good performances in the training (AUC = 0.88; p < 0.001) and validation sets (AUC = 0.75; p < 0.001). The threshold of 47.3 showed a diagnostic odds ratio of 21.0 and 5.4 in the two sets, respectively. All the other tested scores always showed AUCs < 0.70 in both the sets. CCI showed a good stratification ability in terms of graft loss rates in both the sets (log-rank p < 0.001). In the patients exceeding the CCI ninth decile, 1-year graft survival rates were only 0.7% and 23.1% in training and validation sets, respectively. CCI shows a very good diagnostic power for 90-day and 1-year graft loss in different sets of patients, indicating better accuracy with respect to other pre- and post-LT scores.Clinical Trial Notification: NCT03723317.