Natasha H Dolgin1,2,3, Paulo N A Martins4, Babak Movahedi4, Kate L Lapane5, Fred A Anderson6, Adel Bozorgzadeh4. 1. Division of Organ Transplantation, Department of Surgery, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA. natasha.dolgin@umassmed.edu. 2. Department of Quantitative Health Sciences, Clinical & Population Health Research Program, University of Massachusetts Medical School, Worcester, MA, USA. natasha.dolgin@umassmed.edu. 3. Department of Surgery, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA. natasha.dolgin@umassmed.edu. 4. Division of Organ Transplantation, Department of Surgery, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA. 5. Department of Quantitative Health Sciences, Clinical & Population Health Research Program, University of Massachusetts Medical School, Worcester, MA, USA. 6. Department of Surgery, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA.
Abstract
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. 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.
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. 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.
Authors: Cathleen Colón-Emeric; Heather E Whitson; Carl F Pieper; Richard Sloane; Denise Orwig; Kim M Huffman; Janet Prvu Bettger; Daniel Parker; Donna M Crabtree; Ann Gruber-Baldini; Jay Magaziner Journal: J Am Geriatr Soc Date: 2019-08-30 Impact factor: 5.562
Authors: Fernando G Zampieri; Fernando A Bozza; Giulliana M Moralez; Débora D S Mazza; Alexandre V Scotti; Marcelo S Santino; Rubens A B Ribeiro; Edison M Rodrigues Filho; Maurício M Cabral; Marcelo O Maia; Patrícia S D'Alessandro; Sandro V Oliveira; Márcia A M Menezes; Eliana B Caser; Roberto S Lannes; Meton S Alencar Neto; Maristela M Machado; Marcelo F Sousa; Jorge I F Salluh; Marcio Soares Journal: Intensive Care Med Date: 2016-09-29 Impact factor: 17.440
Authors: Margaux N Mustian; Brittany A Shelton; Paul A MacLennan; Rhiannon D Reed; Jared A White; Devin E Eckhoff; Jayme E Locke; Richard M Allman; Stephen H Gray Journal: Transplantation Date: 2019-07 Impact factor: 4.939