Abstract

Background: Comorbidity plays an important role in the mortality of patients both on the waiting list and after liver transplantation (LT). To analyze the impact of comorbidities on LT, a prospective and multicentre study (HEPA_TIC) has been launched.

Methods: Analysis of 1440 consecutive patients included in LT waiting list, in 18 Spanish hospitals, from October 2019 to October 2022. Retransplantation, multivisceral transplantation and patients younger than 16 years were excluded. Comorbidities at the time of listing, and follow-up variables were collected. The analysis of comorbidities was disaggregated by sex. To group comorbidities, three types of unsupervised algorithms were applied using matching-learning: agglomerative clustering, Kmodes, and spectral clustering. Groups were compared by the log Rank test in their evolution.

Results:: Patients were predominantly male (76.6%) with a median age of 61.7 years IQR (56-66); 60.7 years in females IQR (54-67) and 61.8 in males (57-66) (p<0.05). Decompensated cirrhosis was the most frequent indication with no differences in both sexes. Hepatocellular carcinoma was significantly more frequent in males (45.9% vs. 24.6%; p<0.001). The most frequent comorbidities were diabetes and arterial hypertension. Diabetes, COPD and cardiovascular disease were significantly higher in men (p<0.05), while chronic kidney disease was higher in women (p<0.05). Only 8.1% of the listed patients had no comorbidities. The number of comorbidities was higher in males than in females (p<0.001). 34% of the listed men and 19.8% of the women had more than three comorbidities. The number of comorbidities was associated with lower survival after liver transplantation (p=0.04). The three types of algorithms grouped patients into clusters that differed in the prevalence of various comorbidities. Follow-up analyses found significant differences (p>0.05) in survival after transplantation among the clusters defined by the algorithms. Metabolic syndrome represented the greatest difference between the groups. Groups with a higher prevalence of this syndrome had a lower survival rate after transplantation.

Conclusion: Comorbidities are highly prevalent in patients with liver disease on the transplant waiting list, and they differ between men and women. A higher number of comorbidities is associated with lower survival after transplantation. There are patterns of patients with different comorbidities that exhibit differences in survival after LT.