TY - JOUR
T1 - Karnofsky performance status predicts outcomes in candidates for simultaneous liver-kidney transplant
AU - Shamseddeen, Hani
AU - Pike, Francis
AU - Ghabril, Marwan
AU - Patidar, Kavish R.
AU - Desai, Archita P.
AU - Nephew, Lauren
AU - Anderson, Melissa
AU - Kubal, Chandrashekhar
AU - Chalasani, Naga
AU - Orman, Eric S.
N1 - Funding Information:
Research reported in this publication was supported by the National Institutes of Health under award number K23DK109202. This work was supported in part by Health Resources and Services Administration contract 234‐2005‐37011C. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Health and Human Services.
Funding Information:
Research reported in this publication was supported by the National Institutes of Health under award number K23DK109202. This work was supported in part by Health Resources and Services Administration contract 234-2005-37011C. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Health and Human Services.
Publisher Copyright:
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
PY - 2021/2
Y1 - 2021/2
N2 - Karnofsky performance status (KPS), a measure of physical frailty, predicts pre-transplant and post-transplant outcomes in liver transplantation, but has not been assessed in simultaneous liver–kidney transplantation (SLKT). We examined the association between KPS and outcomes in SLKT waitlist registrants and recipients (2005-2018) in the UNOS database. KPS was categorized into A (able to work), B (able to provide self-care), and C (unable to provide self-care). Cox regression and competing risk analysis were used to assess the association between KPS groups and outcomes. A total of 10,785 patients were waitlisted (KPS: 19% A, 46% B, 35% C), and 5,516 underwent SLKT (12% A, 36% B, 52% C). One-year waitlist mortality was 17%, 22%, and 32% for KPS A, B, and C, respectively. In adjusted competing risk regression, KPS C was associated with increased waitlist mortality (SHR 1.15, 95%CI 1.04-1.28). One-year post-transplant survival was 92%, 91%, and 87% for KPS A, B, and C, respectively. In adjusted Cox regression, KPS C was associated with increased post-transplant mortality (HR 1.32, 95%CI 1.08-1.61). It was also associated with increased liver and kidney graft losses and with hospital length of stay. Frailty, as assessed by KPS, is associated with poor outcomes in SLKT pre- and post-transplant.
AB - Karnofsky performance status (KPS), a measure of physical frailty, predicts pre-transplant and post-transplant outcomes in liver transplantation, but has not been assessed in simultaneous liver–kidney transplantation (SLKT). We examined the association between KPS and outcomes in SLKT waitlist registrants and recipients (2005-2018) in the UNOS database. KPS was categorized into A (able to work), B (able to provide self-care), and C (unable to provide self-care). Cox regression and competing risk analysis were used to assess the association between KPS groups and outcomes. A total of 10,785 patients were waitlisted (KPS: 19% A, 46% B, 35% C), and 5,516 underwent SLKT (12% A, 36% B, 52% C). One-year waitlist mortality was 17%, 22%, and 32% for KPS A, B, and C, respectively. In adjusted competing risk regression, KPS C was associated with increased waitlist mortality (SHR 1.15, 95%CI 1.04-1.28). One-year post-transplant survival was 92%, 91%, and 87% for KPS A, B, and C, respectively. In adjusted Cox regression, KPS C was associated with increased post-transplant mortality (HR 1.32, 95%CI 1.08-1.61). It was also associated with increased liver and kidney graft losses and with hospital length of stay. Frailty, as assessed by KPS, is associated with poor outcomes in SLKT pre- and post-transplant.
KW - cirrhosis
KW - liver disease
KW - liver transplantation: living donor
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U2 - 10.1111/ctr.14190
DO - 10.1111/ctr.14190
M3 - Article
C2 - 33320383
AN - SCOPUS:85098256481
SN - 0902-0063
VL - 35
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 2
M1 - e14190
ER -