Background Low medication adherence is known to contribute to worse health outcomes in the general population. Aim We aimed to evaluate the medication regimen and determine the adherence levels among patients with end-stage liver disease. Methods We measured adherence in patients awaiting liver transplantation at a single center using the 8-item Morisky Medication Adherence Scale (MMAS-8), with a score <8 classified as low-adherence. Medication regimen complexity was assessed using the Medication Complexity Regimen tool (MRCI). Factors associated with low-adherence were identified by logistic regression. Results Of 181 patients, 33% were female, median age was 62, and Model for end-stage liver disease (MELD) score was 13. The median (IQR) number of medications was 10 (7–13) and the MRCI was 19 (13–27). 54 (30%) were high adherers, and 127 (70%) were low-adherers. 42% reported sometimes forgetting to take their medication and 22% reported intermittent adherence within the past 2 weeks. The most common reasons for low-adherence were: forgetfulness (27%), and side effects (14%). Compared to high adherence, low-adherence was associated with higher number of medications, medication complexity, and diabetes, but lower rates of hepatocellular carcinoma and self-perceived health. In univariable logistic regression, total medication number (OR 1.08), MRCI (OR 1.04), diabetes (OR 2.38), HCC (OR 0.38) and lower self-perceived health (OR 1.37), were statistically significant factors associated with non-adherence. In multivariate analysis, only medication number without supplements (OR 1.14) remained significantly associated with medication non-adherence. Conclusion A majority of patients awaiting liver transplantation demonstrate low medication adherence. Total number of medications and regimen complexity were strong correlates of adherence. Our data underscore the need for chronic liver disease management programs to improve medication adherence in this vulnerable population.

Cirrhosis leads to sarcopenia and functional decline that can severely impact one’s ability to function at home and in society. Self-reported disability scales to quantify disability – Activities of Daily Living (ADL) and Instrumental ADL (IADL) – are validated to predict mortality in older adults. To evaluate disability in liver transplant (LT) candidates and quantify its impact on outcomes, consecutive outpatients ≥18y listed for LT with laboratory Model for End-stage Liver Disease (MELD) score ≥12 at a single high-volume U.S. LT center were assessed for ADLs and IADLs during clinic visits. Multivariable competing risk models explored the effect of disabilities on waitlist mortality (death or delisting for illness). Of 458 patients: 36% were women, median (IQR) age was 60y (54–64), initial MELD-Na was 16 (13–20). At first visit, 31% had lost ≥1 ADL, 40% ≥1 IADL. The most prevalent ADLs lost were continence (22%), dressing (12%), and transferring (11%); the most prevalent IADLs lost were shopping (28%), food preparation (23%) and medication management (22%). After adjustment for age, MELD-Na, and encephalopathy, dressing (SHR 1.7, 95%CI 1.0–2.8, p=0.04), toileting (SHR 1.9, 95%CI 1.1–3.5, p=0.03), transferring (SHR 1.9, 95%CI 1.1–3.0, p=0.009), housekeeping (SHR 1.8, 95%CI 1.2–3.0, p=0.009), and laundry (SHR 2.2, 95%CI 1.3–3.5, p=0.002), remained independent predictors of waitlist mortality. Conclusion ADL/IADL deficits are common in LT candidates. LT candidates would benefit from chronic disease management programs developed to address the impact of cirrhosis on their daily lives.