Influence of postoperative complications on long-term survival in liver transplant patients.
Clavien
Complication
Comprehensive complication index
Liver transplant
Prognosis
Survival
Journal
World journal of gastrointestinal surgery
ISSN: 1948-9366
Titre abrégé: World J Gastrointest Surg
Pays: United States
ID NLM: 101532473
Informations de publication
Date de publication:
27 Aug 2020
27 Aug 2020
Historique:
received:
05
03
2020
revised:
12
06
2020
accepted:
01
08
2020
entrez:
9
9
2020
pubmed:
10
9
2020
medline:
10
9
2020
Statut:
ppublish
Résumé
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. To analyze the possible influence of postoperative complications on long-term survival and the ability of the comprehensive complication index (CCI) to predict this. 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. 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), A complicated postoperative period - well-defined by means of the CCI score - can influence not only short-term survival, but also long-term survival.
Sections du résumé
BACKGROUND
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
OBJECTIVE
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
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
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),
CONCLUSION
CONCLUSIONS
A complicated postoperative period - well-defined by means of the CCI score - can influence not only short-term survival, but also long-term survival.
Identifiants
pubmed: 32903918
doi: 10.4240/wjgs.v12.i8.336
pmc: PMC7448209
doi:
Types de publication
Journal Article
Langues
eng
Pagination
336-345Informations de copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflict-of-interest statement: The authors declare no conflict of interests.
Références
Ann Surg Oncol. 2016 Dec;23(Suppl 5):929-937
pubmed: 20878244
Med Clin North Am. 2008 Jul;92(4):861-88, ix
pubmed: 18570946
Ann Surg. 2016 May;263(5):1028-37
pubmed: 26020106
World J Transplant. 2015 Dec 24;5(4):300-9
pubmed: 26722658
J Chronic Dis. 1987;40(5):373-83
pubmed: 3558716
Ann Surg. 2017 Dec;266(6):1045-1054
pubmed: 27735824
Transpl Int. 2018 Dec;31(12):1293-1317
pubmed: 30259574
Exp Clin Transplant. 2019 Mar 14;:
pubmed: 30880648
Gastroenterol Hepatol. 2011 Nov;34(9):641-59
pubmed: 22032918
World J Hepatol. 2017 Mar 18;9(8):427-435
pubmed: 28357030
Hepatobiliary Pancreat Dis Int. 2014 Apr;13(2):125-37
pubmed: 24686540
Ann Surg. 2008 Jun;247(6):994-1002
pubmed: 18520227
Ann Surg. 2011 Nov;254(5):745-53; discussion 753
pubmed: 22042468
World J Surg Oncol. 2015 Jun 04;13:194
pubmed: 26040932
Liver Transpl. 2016 Aug;22(8):1129-35
pubmed: 27081833
Ann Surg Oncol. 2014 Mar;21(3):891-8
pubmed: 24254205
Ann Surg. 2015 Mar;261(3):497-505
pubmed: 25185465
Gastroenterol Res Pract. 2018 Nov 19;2018:4396018
pubmed: 30581463
Ann Surg. 2013 Jul;258(1):1-7
pubmed: 23728278
Ann Surg. 2017 Mar;265(3):527-533
pubmed: 28169928
Chin Med J (Engl). 2011 Dec;124(24):4229-35
pubmed: 22340392
Ann Surg. 2004 Aug;240(2):205-13
pubmed: 15273542