title: Preoperative comorbidity correlates inversely with survival after intestinal and multivisceral transplantation in adults.
abstract: We investigated the relationship between preoperative comorbidity and postoperative survival after intestinal transplantation. Each patient received a score for preoperative comorbidity. Each comorbidity was given a score based on the degree it impaired function (score range 0-3). A total score was derived from the summation of individual comorbidity scores. Patients (72 adults (M : F, 33 : 39)) received an isolated intestinal graft (27) or a cluster graft (45). Mean (standard deviation) survival was 1501 (1444) days. The Kaplan-Meier analysis revealed a significant inverse association between survival and comorbidity score (logrank test for trend, P < 0.0001). Patients grouped into comorbidity scores of 0 and 1, 2 and 3, 4 and 5, 6, and above had hazard ratios (95% confidence intervals) for death (compared to group 0 + 1), which increased with comorbidity scores: 1.945 (0.7622-5.816), 5.075 (3.314-36.17), and 13.77 (463.3-120100), respectively, (P < 0.0001). Receiver-operator curves at 1, 3, 5, and 10 years postoperative had "C" statistics of 0.88, 0.85, 0.88, and 0.92, respectively. When evaluating patients for transplantation, the degree of comorbidity should be considered as a major factor influencing postoperative survival.
authors.affiliation: Department of Gastroenterology and Transplantation, Addenbrooke's, Cambridge University Teaching Hospital, Cambridge CB2 0QQ, UK ; Transplantation Surgery, Addenbrooke's, Cambridge University Teaching Hospital, Cambridge CB2 0QQ, UK.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Sivaprakasam
authors.forename: Takahashi
authors.initials: T
authors.lastname: Hidenori
authors.forename: Charlotte
authors.initials: C
authors.lastname: Pither
authors.forename: Seigo
authors.initials: S
authors.lastname: Nishida
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Butler
authors.forename: Eddie R
authors.initials: ER
authors.lastname: Island
authors.forename: Jung
authors.initials: J
authors.lastname: Moon
authors.forename: Muhammad
authors.initials: M
authors.lastname: Dawwas
authors.forename: Simon M
authors.initials: SM
authors.lastname: Gabe
authors.forename: Neville V
authors.initials: NV
authors.lastname: Jamieson
authors.forename: Andreas G
authors.initials: AG
authors.lastname: Tzakis
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Middleton