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Patients with Alcoholic Liver Disease Have Worse Functional Status at Time of Liver Transplant Registration and Greater Waitlist and Post-transplant Mortality Which Is Compounded by Older Age

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A Correction to this article was published on 03 January 2020

This article has been updated

Abstract

Background

Worse functional status correlates with increased mortality on the liver transplant (LT) waitlist. Whether functional status affects LT outcomes equally across cirrhosis etiologies is unclear.

Aims

We evaluate the impact of functional status on waitlist and post-LT mortality stratified by etiology and age.

Methods

Functional status among US adults from 2005 to 2017 United Network for Organ Sharing LT registry data was retrospectively evaluated using Karnofsky Performance Status Score (KPS-1 = functional status 80–100%, KPS-2 = 60–70%, KPS-3 = 40–50%, KPS-4 = 10–30%). Waitlist and post-LT survival were stratified by KPS and cirrhosis etiology, including alcoholic liver disease (ALD), nonalcoholic steatohepatitis (NASH), hepatitis C (HCV), and HCV/ALD, and evaluated using Kaplan–Meier and multivariate Cox proportional hazard models.

Results

Among 94,201 waitlist registrants (69.4% men, 39.5% HCV, 26.7% ALD, 23.2% NASH), ALD patients had worse functional status compared to HCV (KPS-4: 17.2% vs. 8.3%, p < 0.001). Worse functional status at time of waitlist registration was associated with higher 90-day waitlist mortality with the greatest effect in ALD (KPS-4 vs. KPS-1: ALD HR 2.16, 95% CI 1.83–2.55; HCV HR 2.17, 95% CI 1.87–2.51). Similar trends occurred in 5-year post-LT survival with ALD patients the most harmed. Compared to patients < 50 years, patients ≥ 65 years had increased waitlist mortality at 90-days if they had HCV or HCV/ALD, and 5-year post-LT mortality regardless of cirrhosis etiology with ALD patients most severely affected.

Conclusions

In a retrospective cohort study of patients, US ALD patients had disparately worse functional status at time of LT waitlist registration. Worse functional status correlated with higher risk of waitlist and post-LT mortality, affecting ALD and HCV patients the most.

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Change history

  • 03 January 2020

    The original version of the article unfortunately contained an error in Figure��3. X-axis of Figures��3(a-d) should be ���Time in months���. Corrected version of Figure��3 is given.

Abbreviations

ALD:

Alcoholic liver disease

ECOG:

Eastern Cooperative Oncology Group

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

KPS:

Karnofsky Performance Status

LT:

Liver transplantation

MELD:

Model for end-stage liver disease

OPTN:

Organ Procurement and Transplant Network

UNOS:

United Network for Organ Sharing

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine, California Pacific Medical Center, San Francisco, CA, USA

    Patrick McCabe

  2. Department of Medicine, California Pacific Medical Center, San Francisco, CA, USA

    Artin Galoosian

  3. Division of Gastroenterology and Hepatology, Alameda Health System – Highland Hospital, 1411 East 31st Street, Highland Hospital – Highland, Care Pavilion 5th Floor, Endoscopy Unit, Oakland, CA, 94602, USA

    Robert J. Wong

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Correspondence to Robert J. Wong.

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McCabe, P., Galoosian, A. & Wong, R.J. Patients with Alcoholic Liver Disease Have Worse Functional Status at Time of Liver Transplant Registration and Greater Waitlist and Post-transplant Mortality Which Is Compounded by Older Age. Dig Dis Sci 65, 1501–1511 (2020). https://doi.org/10.1007/s10620-019-05891-1

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