More severe deficits in functional status associated with higher mortality among adults awaiting liver transplantation

McCabe, Patrick; Wong, Robert J.

doi:10.1111/ctr.13346

Cited by 15 publications

(16 citation statements)

References 37 publications

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“…( 3,4 ) Frailty is present in 18% to 25% of patients with end‐stage liver disease (ESLD), and it is associated with nearly twice the mortality of reference populations as well as increased hospital admission, waitlist mortality, posttransplant complications, and health care costs. ( 3,5‐7 ) Frailty is also a progressive condition for patients on the waiting list as its prevalence doubles from the time of listing to the time of LT. ( 8,9 )…”

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confidence: 99%

Introducing EL‐FIT (Exercise and Liver FITness): A Smartphone App to Prehabilitate and Monitor Liver Transplant Candidates

et al. 2020

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Preserved physical function is key for successful liver transplantation (LT); however, prehabilitation strategies are underdeveloped. We created a smartphone application (app), EL-FIT (Exercise and Liver FITness), to facilitate exercise training in end-stage liver disease (ESLD). In this feasibility study, we tested EL-FIT app usage and the accuracy of physical activity data transfer and obtained feedback from initial users. A total of 28 participants used the EL-FIT app and wore a physical activity tracker for 38 ± 12 days (age, 60 ± 8 years; 57% males; Model for End-Stage Liver Disease-sodium, 19 ± 5). There was fidelity in data transfer from the tracker to the EL-FIT app. Participants were sedentary (1957 [interquartile range, 873-4643] steps/day) at baseline. Level of training assigned by the EL-FIT app agreed with that from a physical therapist in 89% of cases. Participants interacted with all app features (videos, perceived exertion, and gamification/motivational features). We rearranged training data to generate heart rate-validated steps as a marker of performance and showed that 35% of the participants had significant increases in their physical performance. Participants emphasized their interest in having choices to better engage in exercise, and they appreciated the sense of community the EL-FIT app generated. We showed that patients with ESLD are able to use and interact with the EL-FIT app. This novel smartphone app has the potential of becoming an invaluable tool for home-based prehabilitation in LT candidates.

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confidence: 99%

Introducing EL‐FIT (Exercise and Liver FITness): A Smartphone App to Prehabilitate and Monitor Liver Transplant Candidates

et al. 2020

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“…As a modifiable risk factor, poor functional status (FS) is associated with higher liver transplant (LT) waitlist mortality independent of model for end-stage liver disease (MELD) by a variety of metrics, including Karnofsky performance status score (KPSS) which is an accurate, validated subjective tool in assessing FS as a measure of frailty in patients on the LT waitlist. [1][2][3][4][5] However, whether FS alone is directly causative of higher risk of mortality or whether the impact of FS on waitlist mortality is mediated through other factors is not well understood.…”

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confidence: 99%

Functional Status at Liver Transplant Waitlisting Correlates With Greater Odds of Encephalopathy, Ascites, and Spontaneous Bacterial Peritonitis

McCabe

Hirode

Wong

2020

Journal of Clinical and Experimental Hepatology

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Background & aims: Whether higher liver transplant (LT) waitlist mortality in patients with poor functional status (FS) is mediated by higher prevalence of cirrhosis complications is not clear. We aim to evaluate the impact of FS on risk of hepatic encephalopathy (HE), ascites, and spontaneous bacterial peritonitis (SBP) among adults listed for LT. Methods: Using 2005-2018 United Network for Organ Sharing LT data, we retrospectively evaluated the impact of FS on prevalence of ascites, HE, and SBP among adults listed for LT using Karnofsky Performance Status Score categories (KPSS-1: FS 80-100%, KPSS-2: 60-70%, KPSS-3: 40-50%, KPSS-4: 10-30%), stratified by underlying liver disease etiology. Between-group comparisons used chi-squared methods and adjusted multivariate logistic regression. Results: Among 100,618 adults listed for LT (68.8% male, 72.4% non-Hispanic white) 35.2% were KPSS-1, 36.6% KPSS-2, 15.7% KPSS-3, and 12.6% KPSS-4 at time of LT waitlist registration. Patients with worse FS were significantly more likely to have ascites, HE, and SBP at time of waitlist registration (KPSS-1 vs. KPSS-4: ascites, 66% vs. 93%; HE, 81% vs. 49%; SBP, 4% vs. 16%, p < 0.001 for all). On multivariate regression, compared with patients with KPSS-1, those with KPSS-4 had significantly higher odds of ascites (odds ratio [OR]:

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“…We have demonstrated that children with Medicaid insurance undergoing first‐time isolated liver transplantation have worse outcomes compared to patients with other insurance. Clinical parameters such as renal function, portal vein thrombosis, poor functional status, location in the hospital at the time of transplant, or previous abdominal surgery have been well described as leading to the worst outcomes post‐liver transplantation 8‐12 . Significant emphasis is placed on optimizing these clinical parameters in the perioperative period in order to have excellent post‐transplant outcome.…”

Section: Discussionmentioning

confidence: 99%

Do funding sources influence long‐term patient survival in pediatric liver transplantation?

Dick

Winstanley

O'Hara

et al. 2020

Pediatric Transplantation

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Background Socioeconomic status has been associated with inferior outcomes after multiple surgical procedures, but has not been well studied with respect to pediatric liver transplantation. This study evaluated the impact of insurance status (as a proxy for socioeconomic status) on patient and allograft survival in pediatric first‐time liver transplant recipients. Methods Our retrospective analysis of the UNOS data base from January 2002 through September 2017 revealed 6997 pediatric patients undergoing first‐time isolated liver transplantation. A mixed Cox proportional hazards model adjusted for donor, recipient, and program characteristics determined the RR of insurance status on allograft and patient survival. All results were considered significant at P < .05. All statistical results were obtained using R version 3.5.1 and coxme version 2.2‐10. Results Medicaid status had a significant negative impact on long‐term survival after controlling for multiple covariates. Pediatric patients undergoing first‐time isolated liver transplantation with Medicaid insurance had a RR of 1.42 [confidence interval: 1.18‐1.60] of post‐transplant death. Conclusion Pediatric patients undergoing first‐time isolated liver transplantation have multiple risk factors that may impact long‐term survival. Having Medicaid insurance almost doubles the chances of dying post‐liver transplant. This patient population may require more global support post‐transplant to improve long‐term survival.

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More severe deficits in functional status associated with higher mortality among adults awaiting liver transplantation

Cited by 15 publications

References 37 publications

Introducing EL‐FIT (Exercise and Liver FITness): A Smartphone App to Prehabilitate and Monitor Liver Transplant Candidates

Introducing EL‐FIT (Exercise and Liver FITness): A Smartphone App to Prehabilitate and Monitor Liver Transplant Candidates

Functional Status at Liver Transplant Waitlisting Correlates With Greater Odds of Encephalopathy, Ascites, and Spontaneous Bacterial Peritonitis

Do funding sources influence long‐term patient survival in pediatric liver transplantation?

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