Published online Nov 20, 2019. doi: 10.5500/wjt.v9.i7.145
Peer-review started: March 26, 2019
First decision: March 26, 2019
Revised: October 16, 2019
Accepted: November 6, 2019
Article in press: November 6, 2019
Published online: November 20, 2019
Processing time: 238 Days and 13.5 Hours
The Karnofsky Performance Status (KPS) scale has been widely validated for clinical practice for over 60 years.
To examine the extent to which poor pre-transplant functional status, assessed using the KPS scale, is associated with increased risk of mortality and/or graft failure at 1-year post-transplantation.
This study included 38278 United States adults who underwent first, non-urgent, liver-only transplantation from 2005 to 2014 (Scientific Registry of Transplant Recipients). Functional impairment/disability was categorized as severe, moderate, or none/normal. Analyses were conducted using multivariable-adjusted Cox survival regression models.
The median age was 56 years, 31% were women, median pre-transplant Model for End-Stage for Liver Disease score was 18. Functional impairment was present in 70%; one-quarter of the sample was severely disabled. After controlling for key recipient and donor factors, moderately and severely disabled patients had a 1-year mortality rate of 1.32 [confidence interval (CI): 1.21-1.44] and 1.73 (95%CI: 1.56-1.91) compared to patients with no impairment, respectively. Subjects with moderate and severe disability also had a multivariable-adjusted 1-year graft failure rate of 1.13 (CI: 1.02-1.24) and 1.16 (CI: 1.02-1.31), respectively.
Pre-transplant functional status is a useful prognostic indicator for 1-year post-transplant patient and graft survival.
Core tip: Poor functional status, as defined by The Karnofsky Performance Status scale, is a strong predictor of worse 1-year post-transplant outcomes (patient and graft survival) in a national United States liver transplant population.