Jennifer C Lai1, Jennifer L Dodge2, Saunak Sen3, Kenneth Covinsky4, Sandy Feng2. 1. Department of Medicine, Division of Gastroenterology and Hepatology, University of California-San Francisco, San Francisco, CA. 2. Department of Surgery, Division of Transplant Surgery, University of California-San Francisco, San Francisco, CA. 3. Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA. 4. Department of Medicine, Division of Geriatrics, University of California-San Francisco, San Francisco, CA.
Abstract
UNLABELLED: Cirrhosis is characterized by sarcopenia and malnutrition, leading to progressive functional decline. We aimed to objectively measure functional decline in patients with cirrhosis awaiting liver transplantation and its association with waiting list mortality. Consecutive adults listed for liver transplantation with laboratory Model for End-Stage Liver Disease (MELD) ≥12 at a single center underwent functional status assessments at every outpatient visit using the Short Physical Performance Battery (0 = impaired to 12 = robust), consisting of gait, chair stands, and balance tests. Joint linear time-to-event analyses modeled the simultaneous impact of the longitudinal trajectory of physical function on waiting list mortality (=death or delisted for being too sick for liver transplantation). Included were 309 liver transplantation candidates. Median laboratory MELD was 15, serum albumin was 3.0 g/dL, 28% had ascites, 18% had hepatic encephalopathy, and 83% were Child class B or C. At a median follow-up of 14 months, 15% died or were delisted and 28% underwent liver transplantation. Average physical function worsened per 3 months on the waiting list: -0.38 kg in grip strength, -0.05 meters/second in gait, 0.03 seconds in chair stands, and -0.16 Short Physical Performance Battery points. In joint models of longitudinal trajectories of physical function and waiting list mortality adjusted for MELD-Na, albumin, hepatocellular carcinoma, and baseline physical function, the longitudinal trajectories of each physical function measure were significantly associated with waiting list mortality: grip (hazard ratio = 0.89, 95% confidence interval 0.83-0.95), gait (hazard ratio = 0.72, 95% confidence interval 0.62-0.84), chair stands (hazard ratio = 1.17, 95% confidence interval 1.09-1.25), and Short Physical Performance Battery <10 (hazard ratio = 1.45, 95% confidence interval 1.15-2.20). CONCLUSION: Liver transplantation candidates experience significant functional decline on the waiting list, despite modest wait time and low baseline MELD; decline in physical function is associated with an increased risk of death or delisting, independent of liver disease severity.
UNLABELLED: Cirrhosis is characterized by sarcopenia and malnutrition, leading to progressive functional decline. We aimed to objectively measure functional decline in patients with cirrhosis awaiting liver transplantation and its association with waiting list mortality. Consecutive adults listed for liver transplantation with laboratory Model for End-Stage Liver Disease (MELD) ≥12 at a single center underwent functional status assessments at every outpatient visit using the Short Physical Performance Battery (0 = impaired to 12 = robust), consisting of gait, chair stands, and balance tests. Joint linear time-to-event analyses modeled the simultaneous impact of the longitudinal trajectory of physical function on waiting list mortality (=death or delisted for being too sick for liver transplantation). Included were 309 liver transplantation candidates. Median laboratory MELD was 15, serum albumin was 3.0 g/dL, 28% had ascites, 18% had hepatic encephalopathy, and 83% were Child class B or C. At a median follow-up of 14 months, 15% died or were delisted and 28% underwent liver transplantation. Average physical function worsened per 3 months on the waiting list: -0.38 kg in grip strength, -0.05 meters/second in gait, 0.03 seconds in chair stands, and -0.16 Short Physical Performance Battery points. In joint models of longitudinal trajectories of physical function and waiting list mortality adjusted for MELD-Na, albumin, hepatocellular carcinoma, and baseline physical function, the longitudinal trajectories of each physical function measure were significantly associated with waiting list mortality: grip (hazard ratio = 0.89, 95% confidence interval 0.83-0.95), gait (hazard ratio = 0.72, 95% confidence interval 0.62-0.84), chair stands (hazard ratio = 1.17, 95% confidence interval 1.09-1.25), and Short Physical Performance Battery <10 (hazard ratio = 1.45, 95% confidence interval 1.15-2.20). CONCLUSION: Liver transplantation candidates experience significant functional decline on the waiting list, despite modest wait time and low baseline MELD; decline in physical function is associated with an increased risk of death or delisting, independent of liver disease severity.
Authors: Jennifer C Lai; Kenneth E Covinsky; Hilary Hayssen; Blanca Lizaola; Jennifer L Dodge; John P Roberts; Norah A Terrault; Sandy Feng Journal: Liver Int Date: 2015-02-12 Impact factor: 5.828
Authors: W R Kim; J R Lake; J M Smith; M A Skeans; D P Schladt; E B Edwards; A M Harper; J L Wainright; J J Snyder; A K Israni; B L Kasiske Journal: Am J Transplant Date: 2015-01 Impact factor: 8.086
Authors: Kenneth Rockwood; Xiaowei Song; Chris MacKnight; Howard Bergman; David B Hogan; Ian McDowell; Arnold Mitnitski Journal: CMAJ Date: 2005-08-30 Impact factor: 8.262
Authors: Susan L Murphy; James K Richardson; Jennifer Blackwood; Beanna Martinez; Elliot B Tapper Journal: Dig Dis Sci Date: 2020-01-25 Impact factor: 3.199
Authors: Lorena Puchades; Stephanie Chau; John A Dodson; Yara Mohamad; Rachel Mustain; Adrienne Lebsack; Victoria Aguilera; Martin Prieto; Jennifer C Lai Journal: Transplantation Date: 2018-03 Impact factor: 4.939
Authors: Mathias Plauth; William Bernal; Srinivasan Dasarathy; Manuela Merli; Lindsay D Plank; Tatjana Schütz; Stephan C Bischoff Journal: Clin Nutr Date: 2019-01-16 Impact factor: 7.324
Authors: Jennifer C Lai; Kenneth E Covinsky; Jennifer L Dodge; W John Boscardin; Dorry L Segev; John P Roberts; Sandy Feng Journal: Hepatology Date: 2017-06-28 Impact factor: 17.425
Authors: Michael A Dunn; Deborah A Josbeno; Amit D Tevar; Vikrant Rachakonda; Swaytha R Ganesh; Amy R Schmotzer; Elizabeth A Kallenborn; Jaideep Behari; Douglas P Landsittel; Andrea F DiMartini; Anthony Delitto Journal: Am J Gastroenterol Date: 2016-08-30 Impact factor: 10.864