A decline in functional status while awaiting liver transplantation is predictive of increased post-transplantation mortality

Dmitri Bezinover; Nathaniel R Geyer; Jessica Dahmus; Vernon M Chinchilli; Jonathan G Stine

doi:10.1016/j.hpb.2021.10.008

A decline in functional status while awaiting liver transplantation is predictive of increased post-transplantation mortality

HPB (Oxford). 2022 Jun;24(6):825-832. doi: 10.1016/j.hpb.2021.10.008. Epub 2021 Oct 27.

Authors

Dmitri Bezinover¹, Nathaniel R Geyer², Jessica Dahmus³, Vernon M Chinchilli², Jonathan G Stine⁴

Affiliations

¹ Division of Transplant Anesthesia, Department of Anesthesia and Perioperative Medicine, 500 University Drive, Hershey, PA, 17033, USA; Liver Center, The Pennsylvania State University, Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA.
² Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA, 17033, USA.
³ Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University, Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA.
⁴ Liver Center, The Pennsylvania State University, Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA; Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA, 17033, USA; Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University, Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA; Cancer Institute, The Pennsylvania State University, Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA. Electronic address: jstine@pennstatehealth.psu.edu.

Abstract

Background: Functional status (FS) is dynamic and changes over time. We examined how changes in FS while awaiting liver transplantation influence post-transplant outcomes.

Methods: Data on adult liver transplants performed in the United States during the MELD era were obtained through September 2020. Patient and graft survival were compared between groups with no change or improved FS, and those with worsening FS.

Results: Of the 90,210 transplant recipients included in the analysis, 39,193 (43%) had worsening FS, which was associated with longer waiting-list time (187 vs. 329 days, p < 0.001) and worse patient survival after liver transplant (1858 vs. 1727 days, p < 0.001). A consistent and dose-dependent relationship was observed for each 10-point decrease in Karnofsky Performance Score and post-transplant survival. Multivariable regression analysis confirmed that a decline in FS was associated with worse patient survival (HR 1.15, p < 0.001). Similar findings were observed for graft survival.

Conclusion: A decline in FS on the waiting-list is associated with significantly greater post-liver transplant mortality in recipients. These results should be taken into consideration when allocating organs and determining transplant candidacy. Strategies to optimize FS prior to transplantation should be prioritized as even subtle decreases in FS are associated with inferior post-transplantation outcomes.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Functional Status
Graft Survival
Humans
Liver Transplantation*
Retrospective Studies
United States
Waiting Lists

Grants and funding

L30 DK118601/DK/NIDDK NIH HHS/United States