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©The Author(s) 2026.
World J Hepatol. Jan 27, 2026; 18(1): 111722
Published online Jan 27, 2026. doi: 10.4254/wjh.v18.i1.111722
Published online Jan 27, 2026. doi: 10.4254/wjh.v18.i1.111722
Table 1 Comparison of preoperative characteristics between patients with modified Charlson comorbidity index ≤ 3 and those with modified Charlson comorbidity index > 3, n (%)
| Variables | mCCI ≤ 3 (n = 301) | mCCI > 3 (n = 196) | P value | |
| Age (years) (IQR) | 49 (42, 57) | 57 (50, 61) | < 0.001 | |
| Sex, male | 252 (83.7) | 157 (80.1) | 0.30 | |
| Body mass index (kg/m2) (IQR) | 26 (22.8, 29.7) | 27 (23.2, 30) | 0.46 | |
| Model for end-stage liver disease (IQR) | 16 (11, 22) | 18 (15, 21) | 0.01 | |
| Geographical distribution | Indian | 191 (63.4) | 128 (65.3) | 0.58 |
| Middle East and Egypt | 57 (18.9) | 26 (13.2) | ||
| Asia (other than India) | 26 (8.6) | 23 (11.7) | ||
| North Africans | 10 (3.3) | 6 (3.0) | ||
| Others | 17 (5.6) | 13 (6.6) | ||
| Etiology | Metabolic dysfunction-associated steatohepatitis | 59 (19.6) | 81 (41.3) | < 0.001 |
| Ethanol related | 53 (17.6) | 29 (14.8) | ||
| Viral | 18 (6) | 15 (7.7) | ||
| Cryptogenic | 36 (12) | 16 (8.2) | ||
| Autoimmune | 27 (9) | 10 (5.1) | ||
| Hepatocellular carcinoma | 60 (19.9) | 34 (17.3) | ||
| Others | 48 (15.9) | 11 (5.6) | ||
| Diabetes mellitus | 43 (14.2) | 174 (88.7) | < 0.001 | |
| Hypertension | 56 (18.6) | 65 (33.1) | < 0.001 | |
| Acute kidney injury | 100 (33.2) | 96 (48.9) | < 0.001 | |
| Chronic kidney disease | 0 (0) | 20 (10.2) | < 0.001 | |
| History of preoperative spontaneous bacterial peritonitis | 55 (18.2) | 33 (16.8) | 0.68 | |
| History of preoperative intensive care unit stay with 60 days prior to transplant | 97 (32.2) | 75 (38.2) | 0.16 | |
Table 2 Comparison of intraoperative parameters between the two groups, n (%)/interquartile range
| Intra operative parameters | mCCI ≤ 3 (n = 301) | mCCI > 3 (n = 196) | P value |
| Graft-to-recipient weight ratio | 0.93 (0.78, 1.08) | 0.94 (0.8, 1.12) | 0.37 |
| Intra operative peak lactate (mmol/L) | 4.1 (2.9, 5.6) | 3.6 (2.9, 5.2) | 0.85 |
| Shifting lactates (mmol/L) | 3.4 (2.1, 5) | 3 (2.2, 4.4) | 0.61 |
| Crystalloids intra operative (L) | 2.5 (1.5, 3) | 2.5 (1.5, 3.5) | 0.75 |
| Intra operative packed red blood cells | 3 (1, 5) | 4 (3, 6) | < 0.001 |
| Massive blood transfusion | 51 (16.9) | 45 (22.9) | 0.09 |
| Cold ischemia time (minutes) | 98 (75, 135) | 103 (75, 129) | 0.81 |
| Warm ischemia time (minutes) | 43 (36, 51) | 43 (36, 53) | 0.23 |
| Reperfusion syndrome | 19 (6.3) | 18 (9.1) | 0.23 |
| Surgical duration (minutes) | 540 (438, 578) | 500 (450, 585) | 0.12 |
Table 3 Postoperative outcomes in the two groups, n (%)
| Postoperative outcomes | mCCI ≤ 3 (n = 301) | mCCI > 3 (n = 196) | P value |
| Prolonged vasopressor support from the end of surgery | 129 (42.8) | 74 (37.7) | 0.25 |
| Early allograft dysfunction | 29 (9.6) | 24 (12.2) | 0.35 |
| Incidence of re-exploration surgery | 36 (11.9) | 26 (13.2) | 0.66 |
| Postoperative renal replacement therapy | 11 (3.6) | 21 (10.7) | 0.002 |
| Incidence of sepsis | 53 (17.5) | 37 (18.8) | 0.71 |
| Incidence of prolonged mechanical ventilation | 22 (7.3) | 27 (13.7) | 0.01 |
| Incidence of lung infections | 61 (20.2) | 39 (19.8) | 0.92 |
| Incidence of cardiac complications | 19 (6.3) | 22 (11.2) | 0.05 |
| Incidence of neurological complications | 20 (6.6) | 29 (14.7) | 0.003 |
| Incidence of wound infection | 18 (5.9) | 22 (11.2) | 0.03 |
| Length of ICU stay (days) (IQR) | 6 (5, 8) | 6 (5, 10) | 0.03 |
| Length of hospital stay (days) (IQR) | 16 (13, 20) | 17 (14, 22) | 0.01 |
| ICU re-admission | 29 (9.6) | 33 (16.5) | 0.01 |
| Morbidity (Clavien-Dindo classification ≥ 3b) | 53 (17.6) | 57 (29) | 0.002 |
| 30-day mortality | 6 (1.9) | 10 (5.1) | 0.06 |
| 90-day mortality | 14 (4.6) | 21 (10.7) | 0.01 |
Table 4 Area under the curve for the predictors of outcome after living donor liver transplantation
| Preoperative parameter | Postoperative outcome | Area under the curve | Cut-off | Sensitivity (%) | Specificity (%) |
| MELD | CDC ≥ 3b | 0.51 | > 21 | 40 | 73 |
| 90-day mortality | 0.60 | 42 | 74 | ||
| mCCI | CDC ≥ 3b | 0.57 | > 3 | 52 | 65 |
| 90-day mortality | 0.62 | 63 | 49 | ||
| Combination score [mCCI + (MELD/10)] | CDC ≥ 3b | 0.59 | > 5 | 54 | 65 |
| 90-day mortality | 0.70 | 40 | 87 |
Table 5 Logistic regression analysis of factors associated with postoperative morbidity
| Characteristics of patients | Univariable analysis | Multivariable analysis | ||
| OR | 95%CI | OR | 95%CI | |
| Age | 0.93 | 0.57-1.53 | - | - |
| Sex | 2.12 | 1.28-3.52b | 1.99 | 1.17-3.40a |
| Body mass index | 0.98 | 0.94-1.02 | - | - |
| Smoking | 1.27 | 0.80-2.01 | - | - |
| MELD | 1.02 | 0.66-1.55 | - | - |
| Diabetes mellitus | 1.75 | 1.15-2.69b | 0.7 | 0.4-1.5 |
| Insulin dependent diabetes mellitus | 1.85 | 1.14-3.02b | 0.8 | 0.4-1.6 |
| Coronary artery disease | 1.33 | 0.82-2.18 | - | - |
| Hypertension | 1.01 | 0.62-1.65 | - | - |
| Chronic kidney disease | 2.45 | 0.98-6.16 | - | - |
| Etiology metabolic dysfunction-associated steatohepatitis | 0.94 | 0.49-1.8 | - | - |
| Preoperative intensive care unit stay | 1.99 | 1.29-3.07b | 0.7 | 0.5-1.1 |
| Recurrent large volume paracentesis | 2.10 | 1.34-3.29b | 1.66 | 1.03-2.67a |
| Preoperative need of dialysis | 7.64 | 2.56-22.85b | 6.31 | 2.04-19.47b |
| Intraoperative massive blood transfusion | 2.34 | 1.44-3.82b | 2.33 | 1.40-3.88b |
| Graft-to-recipient weight ratio | 0.99 | 0.94-1.04 | - | - |
| mCCI > 3 | 1.92 | 1.25-2.94b | 1.66 | 1.06-2.60a |
| mCCI + MELD/10 | 2.05 | 1.32-3.18b | 0.99 | 0.96-1.01 |
- Citation: Rajan G, Sam AF, Rajakumar A, Jothimani D, Rela M. Application of modified Charlson comorbidity index for predicting outcomes following adult living donor liver transplantation. World J Hepatol 2026; 18(1): 111722
- URL: https://www.wjgnet.com/1948-5182/full/v18/i1/111722.htm
- DOI: https://dx.doi.org/10.4254/wjh.v18.i1.111722