Liver

56 - Worse Performance Status at Time of Liver Transplant Is Associated With Significantly Lower Survival Following Liver Transplantation

Wednesday, October 10
8:40 AM - 8:50 AM
Location: Terrace Ballroom 4 (level 400)

Category: Liver
Patrick McCabe, MD, MEd1, Benny Liu, MD2, Taft Bhuket, MD2, Robert Wong, MD3
1California Pacific Medical Center/Sutter, San Francisco, CA; 2Highland Hospital, Oakland, CA; 3Alameda Health System - Highland Hospital, Oakland, CA

Introduction: While functional status is an important factor in the evaluation of liver transplantation (LT) eligibility, its impact on post-LT survival is unclear. We aim to evaluate the impact of functional status at time of LT on post-LT survival in U.S. adults.

Methods: Based on 2005-2016 United Network for Organ Sharing data, functional status at time of LT was determined using Karnofsky Performance Status score (KPSS 1: functional status 80-100%, KPSS 2: 60-70%, KPSS 3: 40-50%, KPSS 4: 10-30%). The association of KPSS at time of LT with overall post-LT survival among U.S. adults was evaluated using Kaplan Meier methods and multivariate logistic regression models (adjusted for age, sex, race/ethnicity, liver disease etiology, model for end stage liver disease (MELD) score, insurance type, transplant year, and presence of hepatocellular carcinoma (HCC).

Results: Among 66,397 LT recipients (68% male, 72% non-Hispanic white, 22% HCC, median age: 55-57, 30.4% hepatitis C virus [HCV]), 24% were KPSS 1, 29% KPSS 2, 21% KPSS 3, and 25% KPSS 4. Worse functional status at LT correlated with significantly higher post-LT mortality (compared to KPSS 1: HR for KPSS 2: 1.16, 95% CI 1.10-1.22, HR for KPSS 3: 1.40, 95% CI 1.32-1.49; HR for KPSS 4: 1.67; 95% CI 1.55-1.79; p<0.001 for all).  When stratified by liver disease etiology, among HCV patients, those with KPSS 4 at time of LT had significantly lower 5-year post-LT survival compared to those with KPSS 1 (64.7% vs. 75.6%, p<0.001).  Similar trends were observed in all other etiologies: alcoholic cirrhosis (5-year post-LT survival: 76.0% KPSS 4 vs. 82.9% KPSS 1, p<0.01), combined HCV/alcohol (5-year post-LT survival: 66.6% KPSS 4 vs. 74.5% KPSS 1, p<0.03), nonalcoholic steatohepatitis (5-year post-LT survival: 71.0% KPSS 4 vs. 80.7% KPSS 1, p<0.001).  The higher mortality associated with worse functional status was also observed in patients with and without HCC: with HCC (5-year post-LT survival: 62.1% KPSS 4 vs. 75.3% KPSS 1, p<0.01), without HCC (5-year post-LT survival: 70.9% KPSS 4 vs. 81.1% KPSS 1, p<0.01).

Discussion: Among U.S. adults undergoing LT, incrementally worse functional status at time of LT correlated with significantly lower 5-year post-LT survival. This detrimental impact of poor functional status was observed across etiologies and in patients with and without HCC. Interventions aimed at improving functional status among LT waitlist patients may help improve overall survival and outcomes.


Disclosures:
Patrick McCabe indicated no relevant financial relationships.
Benny Liu indicated no relevant financial relationships.
Taft Bhuket indicated no relevant financial relationships.
Robert Wong: Abbvie – Grant/Research Support. Bayer – Speaker's Bureau. Gilead Sciences – Advisory Committee/Board Member, Consultant, Grant/Research Support, Speaker's Bureau. Salix – Speaker's Bureau.

Patrick McCabe

Dr.
California Pacific Medical Center/Sutter
San Francisco, California

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