title: Functional status predicts postoperative mortality after liver transplantation.
abstract: Frail patients are more vulnerable to perioperative stressors of liver transplantation (LT). Program Specific Reports, used in transplant center auditing, risk-adjust for frailty using the Karnofsky Performance Status (KPS) scale. We evaluate the extent to which functional impairment/disability is associated with increased risk of postoperative death.
  
  
  
  We included 24 505 first-time LT recipients from the Scientific Registry of Transplant Recipients (2006-2011). We categorized patients as Severe, Moderate, or Normal function/disability using the KPS scale and evaluated risk of 30- and 90-day mortality. Analyses took potential center-specific differences in KPS measurement protocols into account using hierarchal logistic modeling.
  
  
  
  Over one-quarter of our population was Severely impaired/disabled, and 30.5% had no functional limitations. Severely and Moderately impaired/disabled patients had 2.56 (95% CI 1.91-3.44) and 1.40 (95% CI 1.10-1.78) times the odds of 30-day mortality, respectively, after adjusting for key recipient and donor factors. Estimates remained consistent regardless of Model for End-Stage Liver Disease score, medical condition, or clustering analyses by center. Technical/operative complications and multiorgan failure/hemorrhage were more common causes of death among more Severely disabled patients than in higher functioning groups.
  
  
  
  Pre-transplant functional status, assessed using the KPS scale, is a reliable predictor of post-LT mortality in the United States.
authors.affiliation: Division of Organ Transplantation, Department of Surgery, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA. natasha.dolgin@umassmed.edu.|Department of Quantitative Health Sciences, Clinical & Population Health Research Program, University of Massachusetts Medical School, Worcester, MA, USA. natasha.dolgin@umassmed.edu.|Department of Surgery, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA. natasha.dolgin@umassmed.edu.
authors.forename: Natasha H
authors.initials: NH
authors.lastname: Dolgin
authors.affiliation: Division of Organ Transplantation, Department of Surgery, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Paulo N A
authors.initials: PN
authors.lastname: Martins
authors.affiliation: Division of Organ Transplantation, Department of Surgery, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Babak
authors.initials: B
authors.lastname: Movahedi
authors.affiliation: Department of Quantitative Health Sciences, Clinical & Population Health Research Program, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Kate L
authors.initials: KL
authors.lastname: Lapane
authors.affiliation: Department of Surgery, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Fred A
authors.initials: FA
authors.lastname: Anderson
authors.affiliation: Division of Organ Transplantation, Department of Surgery, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Adel
authors.initials: A
authors.lastname: Bozorgzadeh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D004185:Disability Evaluation; D005260:Female; D000073496:Frailty / Q000150:complications* / Q000175:diagnosis; D006305:Health Status Indicators; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Karnofsky Performance Status; disability evaluation; end-stage liver disease; liver transplantation; mortality; organ transplants; risk factors