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Patients with Alcoholic Liver Disease Have Worse Functional Status at Time of Liver Transplant Registration and Greater Waitlist and Post-transplant Mortality Which Is Compounded by Older Age

  • Patrick McCabe
  • Artin Galoosian
  • Robert J. WongEmail author
Original Article

Abstract

Background

Worse functional status correlates with increased mortality on the liver transplant (LT) waitlist. Whether functional status affects LT outcomes equally across cirrhosis etiologies is unclear.

Aims

We evaluate the impact of functional status on waitlist and post-LT mortality stratified by etiology and age.

Methods

Functional status among US adults from 2005 to 2017 United Network for Organ Sharing LT registry data was retrospectively evaluated using Karnofsky Performance Status Score (KPS-1 = functional status 80–100%, KPS-2 = 60–70%, KPS-3 = 40–50%, KPS-4 = 10–30%). Waitlist and post-LT survival were stratified by KPS and cirrhosis etiology, including alcoholic liver disease (ALD), nonalcoholic steatohepatitis (NASH), hepatitis C (HCV), and HCV/ALD, and evaluated using Kaplan–Meier and multivariate Cox proportional hazard models.

Results

Among 94,201 waitlist registrants (69.4% men, 39.5% HCV, 26.7% ALD, 23.2% NASH), ALD patients had worse functional status compared to HCV (KPS-4: 17.2% vs. 8.3%, p < 0.001). Worse functional status at time of waitlist registration was associated with higher 90-day waitlist mortality with the greatest effect in ALD (KPS-4 vs. KPS-1: ALD HR 2.16, 95% CI 1.83–2.55; HCV HR 2.17, 95% CI 1.87–2.51). Similar trends occurred in 5-year post-LT survival with ALD patients the most harmed. Compared to patients < 50 years, patients ≥ 65 years had increased waitlist mortality at 90-days if they had HCV or HCV/ALD, and 5-year post-LT mortality regardless of cirrhosis etiology with ALD patients most severely affected.

Conclusions

In a retrospective cohort study of patients, US ALD patients had disparately worse functional status at time of LT waitlist registration. Worse functional status correlated with higher risk of waitlist and post-LT mortality, affecting ALD and HCV patients the most.

Keywords

MELD UNOS/OPTN Cirrhosis Mortality Karnofsky Frailty Liver transplantation 

Abbreviations

ALD

Alcoholic liver disease

ECOG

Eastern Cooperative Oncology Group

HCC

Hepatocellular carcinoma

HCV

Hepatitis C virus

KPS

Karnofsky Performance Status

LT

Liver transplantation

MELD

Model for end-stage liver disease

OPTN

Organ Procurement and Transplant Network

UNOS

United Network for Organ Sharing

Notes

Compliance with Ethical Standards

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Gastroenterology and Hepatology, Department of MedicineCalifornia Pacific Medical CenterSan FranciscoUSA
  2. 2.Department of MedicineCalifornia Pacific Medical CenterSan FranciscoUSA
  3. 3.Division of Gastroenterology and HepatologyAlameda Health System – Highland HospitalOaklandUSA

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