More severe deficits in functional status associated with higher mortality among adults awaiting liver transplantation

Abstract

The impact of functional status on liver transplant (LT) waitlist outcomes is not well studied. Early evidence suggests frailty portends increased mortality. We aim to evaluate the association of functional status with LT waitlist survival and the probability of receiving LT among adults with cirrhosis. Using 2005-2016 United Network for Organ Sharing (UNOS) data, we retrospectively assessed the association of functional status, as determined by Karnofsky Performance Status Score (KPSS) with LT waitlist survival and the probability of receiving LT using Kaplan-Meier and multivariate Cox proportional hazard models. Among 118 954 patients listed for LT, patients with worse Karnofsky scores, indicating poor functional status, were progressively more likely to receive liver transplantation compared to patients with better scores, with the most functionally disabled group having 68% higher probability of receiving LT (HR 1.68; 95% CI 1.61-1.75, P < 0.001). Worse functional status was associated with increased waitlist mortality, with the most functionally disabled group 97% more likely to die on the waitlist (HR 1.97; 95% CI 1.81-2.16, P < 0.001). In conclusion, among patients awaiting LT, worse functional status was associated with significantly higher waitlist mortality.

Functional Status at Liver Transplant Waitlisting Correlates With Greater Odds of Encephalopathy, Ascites, and Spontaneous Bacterial Peritonitis

“…As a modifiable risk factor, poor functional status (FS) is associated with higher liver transplant (LT) waitlist mortality independent of model for end-stage liver disease (MELD) by a variety of metrics, including Karnofsky performance status score (KPSS) which is an accurate, validated subjective tool in assessing FS as a measure of frailty in patients on the LT waitlist. [1][2][3][4][5] However, whether FS alone is directly causative of higher risk of mortality or whether the impact of FS on waitlist mortality is mediated through other factors is not well understood.…”

Do funding sources influence long‐term patient survival in pediatric liver transplantation?

“…We have demonstrated that children with Medicaid insurance undergoing first‐time isolated liver transplantation have worse outcomes compared to patients with other insurance. Clinical parameters such as renal function, portal vein thrombosis, poor functional status, location in the hospital at the time of transplant, or previous abdominal surgery have been well described as leading to the worst outcomes post‐liver transplantation 8‐12 . Significant emphasis is placed on optimizing these clinical parameters in the perioperative period in order to have excellent post‐transplant outcome.…”

Predicting Functional Status After Transplantation in Patients With Acute-on-Chronic Liver Failure

“…This inability to adjust for a potentially reduced survivorship among patients with multiple organ failures is particularly important because the UNOS KPS was associated previously with decreased waiting list and post-LT survival. 2,10 The findings of the current study must be interpreted in light of this missing mortality data. Expressed another way, patients with multiple organ failures receiving a transplant are likely to experience a return of KPS to high levels after LT, provided they survive to 12 months after LT.…”