Functional status predicts postoperative mortality after liver transplantation
AuthorsDolgin, Natasha H.
Martins, Paulo N.A.
Lapane, Kate L.
Anderson, Frederick A. Jr.
Student AuthorsNatasha H. Dolgin
UMass Chan AffiliationsDepartment of Surgery, Center for Outcomes Research
Department of Quantitative Health Sciences, Clinical & Population Health Research Program
Department of Surgery, Division of Organ Transplantation
KeywordsKarnofsky Performance Status
end-stage liver disease
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AbstractBACKGROUND: Frail patients are more vulnerable to perioperative stressors of liver transplantation (LT). Program Specific Reports, used in transplant center auditing, risk-adjust for frailty using the Karnofsky Performance Status (KPS) scale. We evaluate the extent to which functional impairment/disability is associated with increased risk of postoperative death. METHODS: We included 24 505 first-time LT recipients from the Scientific Registry of Transplant Recipients (2006-2011). We categorized patients as Severe, Moderate, or Normal function/disability using the KPS scale and evaluated risk of 30- and 90-day mortality. Analyses took potential center-specific differences in KPS measurement protocols into account using hierarchal logistic modeling. RESULTS: Over one-quarter of our population was Severely impaired/disabled, and 30.5% had no functional limitations. Severely and Moderately impaired/disabled patients had 2.56 (95% CI 1.91-3.44) and 1.40 (95% CI 1.10-1.78) times the odds of 30-day mortality, respectively, after adjusting for key recipient and donor factors. Estimates remained consistent regardless of Model for End-Stage Liver Disease score, medical condition, or clustering analyses by center. Technical/operative complications and multiorgan failure/hemorrhage were more common causes of death among more Severely disabled patients than in higher functioning groups. CONCLUSIONS: Pre-transplant functional status, assessed using the KPS scale, is a reliable predictor of post-LT mortality in the United States.
Clin Transplant. 2016 Nov;30(11):1403-1410. doi: 10.1111/ctr.12808. Epub 2016 Oct 20. Link to article on publisher's site
Permanent Link to this Itemhttp://hdl.handle.net/20.500.14038/33497