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

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.

Comprehensive Complication Index to Monitor Morbidity and Mortality After Liver Transplantation in Primary Sclerosing Cholangitis

“…Previous studies have reported that CCI had prognostic value for graft survival over a relatively short term (within 1 year) 17,18 . One study found that a cutoff value of 47.3 was quite useful because the 1-year liver graft survival rate dropped significantly above this threshold 18 .…”

CONUT Score Predicts Early Morbidity After Liver Transplantation: A Collaborative Study

“…Dindo-Clavien grade I corresponds to 8.7, grade II to 20.9, grade IIIa to 26.2, grade IIIb to 33.7, grade IVa to 42.4, grade IVb to 46.2, and grade V to 100. In the liver transplantation setting, CCI has shown a good prediction ability for 90-day and 1-year graft loss risk (19). The CCI ranges from 0 (i.e., absence of post-operative complications) to 100 (i.e., death) (12,18).…”

The Need to Update Endpoints and Outcome Analysis in the Rapidly Changing Field of Liver Transplantation

“…In patients exceeding the CCI ninth percentile, 1-y graft survival rates were 0.7% and 23.1% in training and validation cohorts, respectively. 14 Other RCTs suggested a 1-y cumulative CD complication ≥3 and CCI as secondary endpoints 64 (Figure 4).…”

“…[10][11][12] As a result of the limited practicability of conventional endpoints attributed to fewer such events, short-term outcomes, and noninferiority have become more common. 11 With patient and graft survival rates exceeding 80% at 1 y, complications as assessed with the Clavien-Dindo (CD) 13 classification (2004) and a few years later (2013) the Comprehensive Complication Index (CCI) 14 were adopted as secondary or surrogate endpoints (SEs) in LT. The expansion of LT for oncological diseases, particularly for HCC as the fifth most common malignancy and the third most common cause of cancer-related mortality, 15 is defined by recurrence risk assessment as, for example, defined by the Milan criteria in 1996.…”

“…44 All these risk scores are built on pretransplant data and mostly remain inferior in their predictive capacity as compared to scoring systems based on "posttransplant" data. 14 To overcome the limitation of binary definitions of EAD, Pareja et al developed the MEAF score, 34 which delivered the ability to continuously assess graft function, implying that the individual scoring of each recipient should provide more detailed information. Agopian et al developed the L-GrAFT score, 35 which allows the individualized calculation of graft failure risk following LT.…”