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Liver failure
PTU-012 The impact of comorbidity on post liver transplant survival and resource utilisation in patients transplanted for acute liver failure utilising the Charlson comorbidity index
  1. M A B Al-Freah,
  2. B Kok,
  3. W Bernal,
  4. G Auzinger,
  5. N D Heaton,
  6. J G O'Grady,
  7. M A Heneghan,
  8. J A Wendon
  1. Institute of Liver Studies, King's College Hospital, London, UK

Abstract

Introduction The presence of comorbidities negatively impact post liver transplant (LT) survival for those transplanted with chronic liver disease.

Methods assess the impact of comorbidities on survival in patients transplanted for acute liver failure (ALF).

Results 176 patients underwent LT for ALF over 9 years. Median follow-up was 92 months (range 35–142). Median age was 33 years (17–67) and 122 (69.3%) were females. Fifty-nine patients (33.5%) were transplanted for Paracetamol induced ALF. Ninety-six (54.6%) patients had ≥1 comorbidity. The commonest comorbidity was renal dysfunction in 84 (48%), pulmonary disease in 10 (6%), connective tissue disease in 5 (3%) and 2 (1%) had diabetes. Patients with ≥1 comorbidity had significantly increased 6 month (25% vs 13%, p=0.046), 12 month (27% vs 13%, p=0.023) and overall mortality (32% vs 17%, p=0.019). Similar results were demonstrated for graft survival. Recipient age ≥ 40 years (OR=1.37, 95% CI 1.02 to 1.86, p=0.039), the presence of comorbidity (OR=1.46, 95% CI 1.05 to 2.03, p=0.022) and renal dysfunction (OR=1.62, 95% CI 1.18 to 2.23, p=0.003) were associated with increased post LT mortality on univariate analysis. However, only the presence of comorbidity (OR=1.43, 95% CI 1.03 to 1.98, p=0.032) and renal dysfunction (OR=1.59, 95% CI 1.15 to 2.19, p=0.004) were independently associated with mortality. Other recipient related, donor, or graft variables were not associated with mortality. Patients with ≥1 comorbidity had significantly increased ICU length of stay (LoS) of 20 days (3 to 134) compared to those without comorbidities, 16 days (2–102), p=0.005.

Conclusion Pre- LT comorbidity as defined by the presence of ≥1 comorbidity, significantly impairs overall post-LT patient and graft survival in patients transplanted for ALF. Patients with ≥1 comorbidity had significantly increased ICU LoS which may suggest increased resource utilisation.

Competing interests None declared.

Reference 1. Volk ML, et al. Modified Charlson comorbidity Index for predicting survival after liver transplantation. Liver Transplant 2007;13:1515–20.

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