Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Nov 20, 2019; 9(7): 145-157
Published online Nov 20, 2019. doi: 10.5500/wjt.v9.i7.145
Impact of recipient functional status on 1-year liver transplant outcomes
Natasha H Dolgin, Babak Movahedi, Frederick A Anderson, Isabel MA Brüggenwirth, Paulo N Martins, Adel Bozorgzadeh
Natasha H Dolgin, Babak Movahedi, Paulo N Martins, Adel Bozorgzadeh, Department of Surgery, Division of Organ Transplantation, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA 01605, United States
Natasha H Dolgin, Department of Quantitative Health Sciences, Clinical and Population Health Research Program, University of Massachusetts Medical School, Worcester, MA 01605, United States
Natasha H Dolgin, Frederick A Anderson, Department of Surgery, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA 01655, United States
Isabel MA Brüggenwirth, Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen 9713GZ, Netherlands
Author contributions: Dolgin NH, Movahedi B, Anderson FA, Brüggenwirth IMA, Martins PN, and Bozorgzadeh A participated in research design; Dolgin NH, Movahedi B, Martins PN, and Bozorgzadeh A analyzed data; Anderson A provided analytic tools; Dolgin NH, Martins PN, and Bozorgzadeh A wrote the paper; Brüggenwirth IMA, Martins PN, and Bozorgzadeh A revised the manuscript; Martins PN and Bozorgzadeh A made the equal contribution.
Institutional review board statement: This study was deemed exempt by the University of Massachusetts Medical School Institutional Review Board.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained from the Scientific Registry of Transplant Recipients (SRTR). The SRTR is contracted to UNOS by the United States Department of Health and Human Services to manage data collected via government-mandated reporting by all United States transplant centers.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Natasha H Dolgin, MD, PhD, Doctor, Department of Surgery, Division of Organ Transplantation, UMass Memorial Medical Center, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655, United States. natasha.dolgin@gmail.com
Telephone: +1-781-6089635
Received: March 26, 2019
Peer-review started: March 26, 2019
First decision: March 26, 2019
Revised: October 16, 2019
Accepted: November 6, 2019
Article in press: November 6, 2019
Published online: November 20, 2019
Abstract
BACKGROUND

The Karnofsky Performance Status (KPS) scale has been widely validated for clinical practice for over 60 years.

AIM

To examine the extent to which poor pre-transplant functional status, assessed using the KPS scale, is associated with increased risk of mortality and/or graft failure at 1-year post-transplantation.

METHODS

This study included 38278 United States adults who underwent first, non-urgent, liver-only transplantation from 2005 to 2014 (Scientific Registry of Transplant Recipients). Functional impairment/disability was categorized as severe, moderate, or none/normal. Analyses were conducted using multivariable-adjusted Cox survival regression models.

RESULTS

The median age was 56 years, 31% were women, median pre-transplant Model for End-Stage for Liver Disease score was 18. Functional impairment was present in 70%; one-quarter of the sample was severely disabled. After controlling for key recipient and donor factors, moderately and severely disabled patients had a 1-year mortality rate of 1.32 [confidence interval (CI): 1.21-1.44] and 1.73 (95%CI: 1.56-1.91) compared to patients with no impairment, respectively. Subjects with moderate and severe disability also had a multivariable-adjusted 1-year graft failure rate of 1.13 (CI: 1.02-1.24) and 1.16 (CI: 1.02-1.31), respectively.

CONCLUSION

Pre-transplant functional status is a useful prognostic indicator for 1-year post-transplant patient and graft survival.

Keywords: Patient survival, Transplantation, Liver disease, Clinical decision-making, Graft survival, Risk assessment/risk stratification

Core tip: Poor functional status, as defined by The Karnofsky Performance Status scale, is a strong predictor of worse 1-year post-transplant outcomes (patient and graft survival) in a national United States liver transplant population.