Reporting functional status in <scp>UNOS</scp>: The weakness of the Karnofsky Performance Status Scale

Wang, Connie W.; Lai, Jennifer C.

doi:10.1111/ctr.13004

Cited by 22 publications

(20 citation statements)

References 12 publications

(10 reference statements)

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“…As noted in the Introduction, weaknesses in the KPS have been discussed. 5,6 In the present context, it is important to note that any measurement error (ie, additional variability) in obtaining patient KPS scores, such as would be demonstrated by poor test-retest or inter-rater reliability, would tend to dilute the putative effects of this factor. That is, if this is true, the relative risks we observed here are too small, and the true effect of KPS is larger.…”

Section: Discussionmentioning

confidence: 98%

“…2 Other characteristics, including grade and stage, 2 have been suggested as well, though only early stages receive transplant under the Milan or UCSF criteria. 4 Functional status at the time of transplant as measured by the Karnofsky Performance Status (KPS), has also been shown to be associated with survival, 5 –8 inasmuch as severity of disability has been similarly recognized in older adults 9 and those with brain injury. 10 Limitations regarding the KPS, 5,6 however, may preclude its use in prognosis.…”

Section: Introductionmentioning

confidence: 99%

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Life Expectancy After Liver Transplantation for Hepatocellular Carcinoma With Cirrhosis

Kwak¹,

Shavelle²,

Brooks³

2021

Prog Transpl

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Background: Hepatocelluar carcinoma, the most common primary liver cancer, has a historically dire prognosis. For hepatic cancer patients with cirrhosis who underwent liver transplantation, we sought to calculate life expectancies both at time of transplant and several years later, stratified by some key variables, and to determine if survival has improved in recent years. Methods: Data on 13,797 hepatic cancer patients with cirrhosis who underwent liver transplantation in the MELD era (2002-2018) from the US Organ Procurement and Transplantation Network database were analyzed using the Cox proportional hazards regression model and life table methods. Results: The major factors related to survival were age, donor age, transplant year, diabetes, functional status, and the presence of severe hepatic encephalopathy. Survival was significantly worse with increasing age and decreasing functional status level. There was no significant difference in survival between males and females. Survival improved over the study period, at 5% per calendar year during the first 5 years post transplant, and 1% per year thereafter. Conclusions: Life expectancies were markedly reduced from normal, even among 5-year survivors with the most favorable characteristics. Survival improved modestly over the years 2002-2018.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Life Expectancy After Liver Transplantation for Hepatocellular Carcinoma With Cirrhosis

Kwak¹,

Shavelle²,

Brooks³

2021

Prog Transpl

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“…Possible drawbacks to use of the KPS have been discussed elsewhere. 26,27…”

Section: Discussionmentioning

confidence: 99%

Life Expectancy after Liver Transplantation for Non-Cirrhotic Hepatocellular Carcinoma

Shavelle¹,

Kwak²,

Saur³

et al. 2021

Prog Transpl

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Background: Hepatocelluar carcinoma typically occurs with underlying cirrhosis. However roughly 20% of cases arise in a non-cirrhotic liver. There is limited literature that addresses the long-term survival of the narrow subgroup who received transplantation. For such patients we sought to calculate life expectancies both at time of transplant and several years later, stratified by key risk factors, and to determine if survival has improved in recent years. Such information can be helpful in making treatment decisions. Methods: Data on 4,373 non-cirrhotic HCC patients who underwent liver transplantation in the MELD era (2002-2018) from the United States OPTN database were analyzed using the Cox proportional hazards regression model and life table methods. Results: Demographic and past medical history factors related to survival were patient age, donor age over 20, and the presence of ascites or severe hepatic encephalopathy. Survival did not vary by race or sex. HCC-specific factors significantly related to survival were the total number of tumors, extrahepatic spread, lymph node involvement, satellite lesions, micro- or macrovascular invasion, tumor differentiation (grade), and pre-transplant treatment. Survival improved over the study period, at 4% per calendar year during the first 5 years post transplant and 1% per year thereafter. Conclusions: Life expectancy in non-cirrhotic HCC transplant patients is much reduced from normal, and varies according to age and tumor-related factors. Survival improved modestly over the study period.

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“…In LT candidates, a study by Dunn et al [7] demonstrated that KPSS is not reliable in reflecting the actual physical activity which was measured in the study via an accelerometer/thermal sensing armband. Second, previous study showed that lower KPSS scores reported were strongly associated with UNOS region, center size, market competition, likely due to bias owing to factors other than functional status [8]. Third, assessment of functional status in cirrhotic populations is profoundly influenced by the incidence of HE, which was not adjusted for in the current analysis.…”

mentioning

confidence: 92%

Functional Status and Liver Disease Phenotype: Frailty, Thy Presence Is Ominous

Izzy

Shingina

2019

Dig Dis Sci

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Reporting functional status in UNOS: The weakness of the Karnofsky Performance Status Scale

Cited by 22 publications

References 12 publications

Life Expectancy After Liver Transplantation for Hepatocellular Carcinoma With Cirrhosis

Life Expectancy After Liver Transplantation for Hepatocellular Carcinoma With Cirrhosis

Life Expectancy after Liver Transplantation for Non-Cirrhotic Hepatocellular Carcinoma

Functional Status and Liver Disease Phenotype: Frailty, Thy Presence Is Ominous

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