Original article
Pancreas, biliary tract, and liver
Karnofsky Performance Status Following Liver Transplantation in Patients With Multiple Organ Failures and Probable Acute-on-Chronic Liver Failure

https://doi.org/10.1016/j.cgh.2019.03.016Get rights and content

Background & Aims

Little is known about outcomes of patients who underwent liver transplantation for acute on chronic liver failure (ACLF) and multiple organ failures. We compared Karnofsky Performance Status (KPS) before and after liver transplantation among patients with different numbers of organ failures and probable ACLF.

Methods

We performed a retrospective cohort study of adults who underwent liver transplantation within 30 days of listing with the United Network for Organ Sharing (UNOS) network from January 1, 2006, through September 30, 2016. We determined the prevalence of organ failures using a modified version of the Chronic Liver Failure-Sequential Organ Failure Assessment scale and collected KPS scores at the time of transplantation and at intervals of 3 to 12 months after liver transplantation. Multivariate analyses were performed to adjust for confounders including UNOS region.

Results

At the time of liver transplantation, 2838 patients had no organ failure, 2944 had 1 to 2 organ failures, and 1342 patients had 3 or more organ failures. KPS scores following liver transplantation improved significantly in all groups; scores ranged from 81 in patients with no organ failure to 72 in patients with 5 to 6 organ failures. Excellent performance status (KPS score, ≥80) by 1 year after transplantation was achieved by 60% of patients with 5 to 6 organ failures, 64% to 66% of patients with 3 to 4 organ failures, and 70% to 71% of patients with 1 to 2 organ failures, compared with 72.5% of patients without organ failure. Patients with 1 to 4 organ failure were more likely to achieve KPS scores of 80 or more than patients without organ failure, after we adjusted for other covariates and UNOS region. In addition, black patients were less likely, and patients with alcoholic cirrhosis were more likely, to have KPS scores of 80 or more after liver transplantation.

Conclusions

In a retrospective cohort study of patients with probable ACLF who underwent liver transplantation within 30 days of listing with the UNOS network, 60% to 66% of patients with 3 or more organ failures achieved excellent performance 3 to 12 months later.

Section snippets

Patients and Methods

We included adult patients (age, >18 y) who received a transplant within 30 days of listing with the United Network for Organ Sharing (UNOS) between January 1, 2006, and September 30, 2016. The start date of January 1, 2006, was selected because KPS scores were collected consistently since 2006. Among these patients, we determined the prevalence of OF using a modified version of the Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) scale.16 The organ failure types included

Results

During the study period, KPS scores of 7124 patients who received a transplant within 30 days of listing were available for the analysis. Of those, 2838 had no OF, 1587 had 1 OF, 1357 had 2 OFs, 731 had 3 OFs, 365 had 4 OFs, and 246 had 5 to 6 OFs. Patients who had LT in the presence of multiple OFs were relatively younger compared with those without OF (Table 1). The mean MELD scores were lower (16.5 ± 5.8) in patients without OF compared with patients with 1 to 6 OFs (Table 1). In patients

Discussion

This retrospective cohort analysis showed that the majority of patients (60%–67%) with 3 or more OFs achieved excellent performance status (KPS score, >80) after LT compared with 74% in patients without OFs. Our findings are very reassuring considering that many of these patients had 3 or more organ failures and were in the intensive care unit (ICU) at the time of LT. More importantly, all 246 patients with 5 to 6 OFs were on circulatory support and 227 (92.3%) were on ventilatory support,

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Conflicts of interest The authors disclose no conflicts.

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