Application of modified Charlson comorbidity index for predicting outcomes following adult living donor liver transplantation

doi:10.4254/wjh.v18.i1.111722

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World Journal of Hepatology

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1948-5182

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Hepatol. Jan 27, 2026; 18(1): 111722
Published online Jan 27, 2026. doi: 10.4254/wjh.v18.i1.111722

Application of modified Charlson comorbidity index for predicting outcomes following adult living donor liver transplantation

Gowtham Rajan, Amal Francis Sam, Akila Rajakumar, Dinesh Jothimani, Mohamed Rela

Gowtham Rajan, Department of Liver Anaesthesiology and Critical Care, Dr. Rela Institute, Chennai 600044, Tamil Nadu, India

Amal Francis Sam, Department of Liver Anaesthesiology and Critical Care, Institute of Liver Disease and Transplantation, Chennai 600044, Tamil Nadu, India

Akila Rajakumar, Department of Liver Transplant Anaesthesia and Intensive Care, Institute of Liver Disease and Transplantation, Dr. Rela Institute, Chennai 600044, Tamil Nadu, India

Dinesh Jothimani, Department of Hepatology, Dr. Rela Institute, Chennai 600044, Tamil Nadu, India

Mohamed Rela, Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai 600044, Tamil Nadu, India

Co-first authors: Gowtham Rajan and Amal Francis Sam.

Author contributions: Rajan G and Sam AF were responsible for conceptualization of methodology and conducting the study, data curation, and formal analysis as co-first authors; Rajakumar A was responsible for conceptualization, formal analysis, supervision, validation, and original draft preparation; Jothimani D and Rela M were responsible for supervision, writing, review, and editing; all of the authors read and approved the final version of the manuscript to be published.

Institutional review board statement: The study was reviewed and approved by the Institutional Ethics committee, No. ECR/1276/Inst/TN/2019/2025/312.

Informed consent statement: Being a retrospective study, informed consent was waived by the Institutional Ethics Committee, No. ECR/1276/Inst/TN/2019/2025/312.

Conflict-of-interest statement: The authors do not have any conflicts of interest to disclose.

Data sharing statement: The data is available upon reasonable request from the corresponding author.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Akila Rajakumar, MD, FRCA, Head, Department of Liver Transplant Anaesthesia and Intensive Care, Institute of Liver Disease and Transplantation, Dr. Rela Institute, No. 7 CLC Works Road, Chennai 600044, Tamil Nadu, India. drakila.rajakumar@gmail.com

Received: July 8, 2025
Revised: August 29, 2025
Accepted: November 24, 2025
Published online: January 27, 2026
Processing time: 203 Days and 16 Hours

Abstract

BACKGROUND

The model for end-stage liver disease (MELD) score helps assess the severity of liver disease and can predict survival after liver transplant. The Charlson comorbidity index (CCI) is frequently employed to forecast the 10-year survival probability of patients with multiple health conditions. We employed the CCI to evaluate the impact of comorbid health conditions on patients and assess its predictive capability regarding health complications and mortality following living donor liver transplantation (LDLT).

AIM

To understand the prevalence of extrahepatic comorbidities in our cohort of LDLT patients with modified CCI (mCCI) and to analyze the utility of mCCI as a predictor of morbidity and mortality following LDLT.

METHODS

After obtaining institutional ethics committee approval, a retrospective analysis was conducted on 497 adult patients who underwent LDLT at our institute between January 2021 and December 2023.

RESULTS

Our analysis revealed that the area under the curve (AUC) of the original CCI for predicting 90-day mortality decreased when malignancy was assigned a score of 2 in patients with hepatocellular carcinoma undergoing transplantation. Therefore, we used a mCCI. Both MELD and mCCI scores demonstrated predictive value for 90-day mortality, with AUCs of 0.60 and 0.62, respectively. Using regression coefficients, we developed a composite score defined as: Combined score = [mCCI + (MELD/10)]. This composite metric improved predictive accuracy, yielding an AUC of 0.70 for 90-day mortality prediction. Patients with a CCI > 3 and a MELD > 21 had a significantly higher 90-day mortality rate than others (12.5% vs 5.7%; P = 0.02).

CONCLUSION

The mCCI was independent of decompensation and overall disease severity. Combining MELD and CCI scores enhanced the discriminatory power for predicting morbidity and 90-day mortality.

Keywords: Charlson comorbidity index; Post living donor liver transplantation outcomes; Composite outcome scores in living donor liver transplantation; Charlson comorbidity index vs model for end-stage liver disease; Modified Charlson comorbidity index in liver transplantation; Outcome prediction in living donor liver transplantation

Core Tip: With advances in surgical techniques and perioperative care, the outcomes of liver transplantation have improved significantly, encouraging its use in more elderly patients and those with more comorbidities. In addition to liver disease severity, understanding the impact of extra-hepatic comorbidities on the outcomes will help in prognostication and risk stratification with appropriate resource planning. The Charlson comorbidity index has been validated as a good predictor of long-term survival in varied clinical populations. With limited studies regarding its use in liver transplant patients, we aimed to study its applicability in a cohort of living donor liver transplant patients.