Predictive Value of the Charlson Comorbidity Index in Kidney Transplantation

BACKGROUND: Nonimmunologic factors have been recently implicated in worseoutcomes after kidney transplantation, producing a need to predict the operative risk among kidney recipients. We assessed the predictive value of the Charlsoncomorbidity index (CCI) among kidney transplant recipients.METHODS: A retrospective study of 223 first deceased-donor kidneytransplantations performed from 2000 to 2007 evaluated the role of comorbidities.RESULTS: About 50% of recipients displayed >1 comorbid condition beforetransplantation; the most frequently reported was diabetes mellitus. IncreasingCCI scores significantly affected graft and patient survivals. Crude analysisshowed a significant association between CCI >1 and risk of death (hazard ratio[HR], 3.87; 95% confidence interval [CI], 1.06-14.06; P = .04). After adjustment for several covariates, high CCI values remained significantly predictive ofposttransplantation outcomes with a HR for death of (12.53; 95% CI, 1.9-82.68; P = .009).CONCLUSIONS: Our predictive model showed a strong association of CCI and patient survival even after adjustment for several clinical covariates. CCI may be usedto evaluate patients referred for kidney transplantation who display asignificant burden of comorbid conditions that increase the risk of prematuredeath or graft loss.