Quality of Life in Liver Transplant Candidates

Derck, J.; Thelen, Angela E.; Cron, David C.; Friedman, Jeffrey F.; Gerebics, A.; Englesbe, Michael J.; Sonnenday, Christopher J.

doi:10.1097/tp.0000000000000593

Cited by 65 publications

(12 citation statements)

References 31 publications

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“…2 Frailty and decreased 6-minute walking distance are associated with death and diminished quality of life in liver transplant candidates. 3–5 …”

Section: Introductionmentioning

confidence: 99%

“…To address this question, we examined the United Network for Organ Sharing (UNOS) database, which contains information on all patients listed for liver transplantation in the US. Compared to prior studies of frailty, which were all single-center, 2–5 the UNOS database offers the advantages of (1) a large population-wide analysis from multiple centers and (2) the use of KPS data collected as part of routine clinical care, allowing for improved generalizability.…”

Section: Introductionmentioning

confidence: 99%

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Poor Performance Status Is Associated With Increased Mortality in Patients With Cirrhosis

Orman

Ghabril

Chalasani

2016

Clinical Gastroenterology and Hepatology

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Background & Aims Functional status (a patient’s ability to perform activities that meet basic needs, fulfill usual roles, and maintain health and well being) has been linked to outcomes in patients with cirrhosis and can be measured by the Karnofsky performance status (KPS) scale. We investigated the association between KPS score and mortality in patients with cirrhosis. Methods We used the United Network for Organ Sharing database to perform a retrospective cohort study of patients listed for liver transplantation in the United States between 2005 and 2015. We used Cox proportional hazards and competing risk regression analyses to examine the association between KPS and mortality and transplantation. Results Of 79,092 patients, 44% were in KPS category A (KPS 80%–100%), 43% were in category B (KPS 50%–70%), and 13% were in category C (KPS 10%–40%). Between 2005 and 2015, the proportion of patients in category A decreased from 53% to 35%, whereas the proportions in categories B and C increased from 36% to 49% and from 11% to 16%, respectively. KPS was associated with mortality: compared to patients in KPS category A, the KPS B adjusted hazard ratio [HR] was 1.14 (95% confidence interval [CI], 1.11–1.18) and the KPS C adjusted HR was 1.63 (95% CI, 1.55–1.72). KPS was also associated with liver transplantation; compared to patients in KPS category A, the KPS B adjusted HR was 1.08 (95% CI, 1.06–1.11) and the KPS C adjusted HR was 1.35 (95% CI, 1.30–1.40). In competing risk analysis, only the relationship between KPS and mortality maintained significance and directionality. These relationships were most pronounced in patients without hepatocellular carcinoma. Conclusions Among patients with cirrhosis listed for liver transplantation, poor performance status, based on the KPS scale, is associated with increased mortality. In this population, performance status has decreased over time.

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“…2 Frailty and decreased 6-minute walking distance are associated with death and diminished quality of life in liver transplant candidates. 3–5 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Poor Performance Status Is Associated With Increased Mortality in Patients With Cirrhosis

Orman

Ghabril

Chalasani

2016

Clinical Gastroenterology and Hepatology

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“…Frailty could play a role in a “blended principle model” [ 1 ] of organ allocation, as it is able to assess patients’ overall health status and at the same time potential to be a predictor of both mortality and quality of life [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…Derck et al [ 23 ], recently showed that frailty phenotype outperformed MELD in predicting quality of life in the pre-transplant period.…”

Section: Introductionmentioning

confidence: 99%

A frailty index predicts post-liver transplant morbidity and mortality in HIV-positive patients

et al. 2017

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BackgroundWe hypothesized that frailty acts as a measure of health outcomes in the context of LT. The aim of this study was to explore frailty index across LT, as a measure of morbidity and mortality. This was a retrospective observational study including all consecutive 47 HIV+patients who received LT in Modena, Italy from 2003 to June 2015.Methodsfrailty index (FI) was constructed from 30 health variables. It was used both as a continuous score and as a categorical variable, defining ‘most frail’ a FI > 0.45. FI change across transplant (deltaFI, ΔFI) was calculated as the difference between year 1 FI (FI–Y1) and pre-transplant FI (FI–t0). The outcomes measures were mortality and “otpimal LT” (defined as being alive without multi-morbidity).ResultsMedian value of FI–t0 was 0.48 (IQR 0.42–0.52), FI–Y1 was 0.31 (IQR 0.26–0.41). At year five mortality rate was 45%, “optimal transplant” rate at year 1 was 38%. All the patients who died in the post-LT were most frail in the pre-LT. ΔFI was a predictor of mortality after correction for age and MELD (HR = 1.10, p = 0.006) and was inversely associated with optimal transplant after correction for age (HR = 1.04, p = 0.01).ConclusionsWe validated FI as a valuable health measure in HIV transplant. In particular, we found a relevant correlation between FI strata at baseline and mortality and a statistically significant correlation between, ΔFI and survival rate.Electronic supplementary materialThe online version of this article (doi:10.1186/s12981-017-0163-x) contains supplementary material, which is available to authorized users.

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“…Research on ESLD has focused primarily on patients who are liver transplant candidates Stewart, Hart, Gibson, & Fisher, 2014) and pre-and post-transplantation (Garcia-Rodriguez et al, 2015; Kalaitzakis et al, 2012). Patients awaiting transplantation experience marked worsening of overall health (Lai et al, 2015), physical symptoms like fatigue, affective symptoms like depression and anxiety (Stewart et al, 2014), uncertainty (Kimbell, Boyd, Kendall, Iredale, & Murray, 2015) poor QOL, fear of dying (Bjork & Naden, 2008;Derck et al, 2015), and worsening ascites and confusion due to hepatic encephalopathy (Onyekwere, Ogbera, & Hameed, 2011). Adults with ESLD toward the end of life experience pain (Hansen, Leo, Chang, Zucker, & Sasaki, 2014), symptom distress (Hansen et al, 2015), dyspnea, and depression (Poonja et al, 2014).…”

Section: Physical and Psychological Symptoms In Patients With Esldmentioning

confidence: 99%

Background and design of the symptom burden in end‐stage liver disease patient‐caregiver dyad study

Hansen

Lyons

Dieckmann

et al. 2017

Research in Nursing & Health

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Over half a million Americans are affected by cirrhosis, the cause of end-stage liver disease (ESLD). Little is known about how symptom burden changes over time in adults with ESLD and their informal caregivers, which limits our ability to develop palliative care interventions that can optimize symptom management and quality of life in different patient-caregiver dyads. The purpose of this article is to describe the background and design of a prospective, longitudinal descriptive study, “Symptom Burden in End-Stage Liver Disease Patient-Caregiver Dyads,” which is currently in progress. The study is designed to (1) identify trajectories of change in physical and psychological symptom burden in adults with ESLD; (2) identify trajectories of change in physical and psychological symptom burden in caregivers of adults with ESLD; and (3) determine predictors of types of patient-caregiver dyads that would benefit from tailored palliative care interventions. We aim for a final sample of 200 patients and 200 caregivers who will be followed over 12 months. Integrated multilevel and latent growth mixture modeling will be used to identify trajectories of change in symptom burden, linking those changes to clinical events and quality of life outcomes and characterizing types of patient-caregiver dyads based on patient-, caregiver-, and dyad-level factors. Challenges we have encountered include unexpected attrition of study participants, participants not returning their baseline questionnaires, and hiring and training of research staff. The study will lay the foundation for future research and innovation in ESLD, end-of-life and palliative care, and caregiving.

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Quality of Life in Liver Transplant Candidates

Cited by 65 publications

References 31 publications

Poor Performance Status Is Associated With Increased Mortality in Patients With Cirrhosis

Poor Performance Status Is Associated With Increased Mortality in Patients With Cirrhosis

A frailty index predicts post-liver transplant morbidity and mortality in HIV-positive patients

Background and design of the symptom burden in end‐stage liver disease patient‐caregiver dyad study

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