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dc.contributor.authorDolgin, Natasha H.
dc.contributor.authorMartins, Paulo N.A.
dc.contributor.authorMovahedi, Babak
dc.contributor.authorLapane, Kate L.
dc.contributor.authorAnderson, Frederick A. Jr.
dc.contributor.authorBozorgzadeh, Adel
dc.date2022-08-11T08:08:56.000
dc.date.accessioned2022-08-23T16:12:54Z
dc.date.available2022-08-23T16:12:54Z
dc.date.issued2016-11-01
dc.date.submitted2017-09-06
dc.identifier.citation<p>Clin Transplant. 2016 Nov;30(11):1403-1410. doi: 10.1111/ctr.12808. Epub 2016 Oct 20. <a href="https://doi.org/10.1111/ctr.12808">Link to article on publisher's site</a></p>
dc.identifier.issn0902-0063 (Linking)
dc.identifier.doi10.1111/ctr.12808
dc.identifier.pmid27439897
dc.identifier.urihttp://hdl.handle.net/20.500.14038/33497
dc.description.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.
dc.language.isoen_US
dc.relation<p><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=27439897&dopt=Abstract">Link to Article in PubMed</a></p>
dc.relation.urlhttps://doi.org/10.1111/ctr.12808
dc.subjectKarnofsky Performance Status
dc.subjectdisability evaluation
dc.subjectend-stage liver disease
dc.subjectliver transplantation
dc.subjectmortality
dc.subjectorgan transplants
dc.subjectrisk factors
dc.subjectClinical Epidemiology
dc.subjectEpidemiology
dc.subjectSurgery
dc.titleFunctional status predicts postoperative mortality after liver transplantation
dc.typeJournal Article
dc.source.journaltitleClinical transplantation
dc.source.volume30
dc.source.issue11
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/gsbs_sp/2022
dc.identifier.contextkey10714528
html.description.abstract<p>BACKGROUND: 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.</p> <p>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.</p> <p>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.</p> <p>CONCLUSIONS: Pre-transplant functional status, assessed using the KPS scale, is a reliable predictor of post-LT mortality in the United States.</p>
dc.identifier.submissionpathgsbs_sp/2022
dc.contributor.departmentDepartment of Surgery, Center for Outcomes Research
dc.contributor.departmentDepartment of Quantitative Health Sciences, Clinical & Population Health Research Program
dc.contributor.departmentDepartment of Surgery, Division of Organ Transplantation
dc.source.pages1403-1410
dc.contributor.studentNatasha H. Dolgin


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