Photo Credit: Marco Marca

Patients with a preop, age-adjusted Charlson Comorbidity Index score higher than 3 had a much greater risk for postop complications after kidney transplant.

Patients with a preoperative, age-adjusted Charlson Comorbidity Index (ACCI) score greater than 3 had a significantly elevated risk of postoperative complications following kidney transplantation compared with other renal transplant patients, according to study results published online in BMC Nephrology.

“According to the ACCI scale, the baseline ACCI score for all renal transplant patients is 2, without factoring in any other comorbidities,” researchers wrote. “The patients with ESRD [end-stage renal disease] and age greater than 50 [years] all had an ACCI score of 3 at baseline.”

The retrospective observational study included 859 patients with ESRD who underwent kidney transplantation at a single center between January 2015 and March 2021. Of these, 469 had an ACCI score of 3 or less, and 390 had scores higher than 3.

Comorbidities Associated With Post-Op Complications

According to the study, 264 patients, or 30.7% of the patient sample, experienced complications after surgery. Nearly 60% of patients with postoperative complications had a preoperative ACCI score greater than 3.

Researchers reported that after multivariate adjustment, the odds ratio (OR) for postoperative complications with an ACCI score above 3 was 1.64, compared with scores of 3 or less.

“An ACCI value exceeding 3 preoperatively constituted a risk factor for postoperative complications among patients [with kidney transplant],” the authors wrote.

The five preoperative ACCI comorbidities most strongly associated with postoperative complications were congestive heart failure (researchers reported an OR of 16.18), cerebrovascular disease (6.85), chronic obstructive pulmonary disease (6.05), peripheral vascular disease (2.32), and mild liver disease (1.80).

Using ACCI Scores in Clinical Settings

“These findings emphasize the significance of considering these specific comorbidities when evaluating the risk of postoperative complications [after] kidney transplantation,” researchers wrote.

Seventeen patients died during hospitalization after kidney transplantation, the study found. Survival rates at 30, 50, and 100 days were significantly lower in patients with ACCI scores above 3 compared with patients with scores of 3 or less.

Researchers pointed out that calculating a patient’s ACCI score is not difficult and can usually be determined with a medical history and exam. As such, the strategy offers practicality and broad applicability.

“By utilizing the ACCI score, we can proactively identify high-risk individuals who are likely to experience postoperative complications following kidney transplant surgery,” investigators wrote.