Disability in patients with end‐stage liver disease: Results from the functional assessment in liver transplantation study

Abstract

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.

Physical frailty after liver transplantation

“…3 While several studies have investigated frailty 1,4 or aspects of frailty (eg, cardiopulmonary fitness, 5,6 disability, 7,8 ) in the pre–liver transplant setting, these tools have characteristics that have hampered efforts to fully understand if, how, and when frailty reverses after liver transplantation. For example, tools such as the Fried Frailty Index or Activities of Daily Living scale are subjective and scored on a noncontinuous scale, making them insensitive to subtle changes over time; cardiopulmonary exercise testing is technically challenging to administer, limiting the number of patients who are able to undergo repeat posttransplant testing.…”

Assessing the Time‐Dependent Impact of Performance Status on Outcomes After Liver Transplantation

“…(7,8) In patients on the transplant waitlist, impaired PS has been shown to have important adverse effects on quality of life as well as survival. (5,6,9) In patients who have received a liver transplant (LT), the impact of pretransplant PS on posttransplant survival is less well described. One commonly used PS score shown to have a strong association with mortality in nontransplanted patients with CLD is the Eastern Cooperative Oncology Group (ECOG) scale.…”

Impact of cancer rehabilitation on the prognosis of patients with hepatocellular carcinoma

“…Sarcopenia frequently occurs in patients with chronic liver disease (CLD) regardless of its etiology (7,8). Sarcopenia in patients with CLD is associated with a decline in their quality of life and physical activity (9). Sarcopenia is also significantly associated with hepatic fibrosis (10).…”