Published in:
Open Access
01-02-2021 | Liver Transplantation | Original Article
The role of the comprehensive complication index for the prediction of survival after liver transplantation
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
Published in:
Updates in Surgery
|
Issue 1/2021
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Abstract
In 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.