ACCI value over 3 may predict risk of complications among kidney transplant patients: Study

A new study published in the journal of BMC Nephrology shows that kidney transplant (KT) patients were at risk for postoperative problems if their preoperative age-adjusted Charlson Comorbidity Index (ACCI) value was more than 3.

The best course of treatment for end-stage renal disease (ESRD) is seen to be kidney transplantation. Kidney transplantation considerably increases life expectancy and improves quality of life when compared to long-term dialysis. But it is important to be mindful of any problems that might harm people. A worse quality of life, a higher risk of a brief postoperative readmission, higher medical costs, and even potentially fatal circumstances might result from these problems.

Graft failure, cardiovascular complications (heart failure, cardiac arrest, arrhythmias), infectious complications (pulmonary infections, urinary tract infections), urological complications (ureteral stenosis), and neurological complications (cerebrovascular disease, peripheral neuropathy) are some of the most common post-operative complications of kidney transplantation.

One well-known and often-used instrument for assessing comorbidities in clinical research is the Charlson Comorbidity Index (CCI). In patients with end-stage renal illness receiving dialysis and kidney transplantation, the Charlson Comorbidity Index has demonstrated prognostic significance for both short-term and long-term outcomes. Studies have linked early fracture-related morbidity in femur fractures treated with cervical fixation to high CCI scores. This study was set out to evaluate the relationship between the postoperative problems kidney transplant patients and the ACCI.

This research with 886 kidney transplant patients was carried out at the Third Affiliated Hospital of Sun Yat-sen University from January 2015 to March 2021. The Clavien-Dindo Classification of Surgical Complications was used to characterize postoperative complications. To evaluate the relationship between ACCI and postoperative problems, Target Maximum Likelihood Estimation (TMLE) was utilized. To ascertain the association between ACCI and postoperative complications, the odds ratio (OR) was calculated. Stratified and subsequent interaction analyses were conducted to evaluate the findings' robustness.

Postoperative problems were reported in 30.7% of the 859 KT patients who were eventually included in the research. After multivariable correction, those with an ACCI score greater than 3 showed a noticeably higher risk of postoperative problems. The 3 preoperative comorbidities most strongly associated with postoperative problems in ACCI were peripheral vascular disease, congestive heart failure, and chronic obstructive pulmonary disease.

Overall, one possible risk factor for postoperative problems in kidney transplant recipients is having a preoperative ACCI score higher than 3. This can help to proactively identify high-risk patients who are likely to have postoperative difficulties after kidney transplant surgery by using the ACCI score.

Reference:

Huang, Q., Luo, T., Yang, J., Lu, Y., Zhou, S., Hei, Z., & Chen, C. (2024). Association between the age-adjusted Charlson Comorbidity Index and complications after kidney transplantation: a retrospective observational cohort study. In BMC Nephrology (Vol. 25, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12882-024-03888-1