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LT candidates experience decreased physical function while waitlisted

Liver transplantation candidates with cirrhosis experienced significant decline in physical functioning while waitlisted for transplant. This decreased function was also associated with increased risk for mortality, according to data published in Hepatology.

“We hypothesized that liver transplant candidates experience accelerated function decline and that the trajectory of change in physical function is associated with waiting list mortality, independent of baseline physical function,” Jennifer C. Lai, MD, of the division of gastroenterology and hepatology, University of California San Francisco, and colleagues wrote.

To test their hypothesis, the researchers analyzed data of 309 patients from the Functional Assessment in Liver Transplantation (FrAILT) study, an ongoing prospective cohort study of adults with cirrhosis actively listed for LT at UC San Francisco. Multiple models, including four separate joint models (grip strength, gait speed, chair stands and Short Physical Performance Battery) were created to model the impact of longitudinal trajectory of physical function on mortality or delisted status.

Over a median follow-up of 14 months, 15% of patients died or were delisted and 28% underwent LT.

According to analyses, the average physical function decreased at the following rate every 3 months on the waitlist: − 0.38 kg in grip strength, − 0.05 m/second in gait speed, 0.03 seconds in chair stands, and − 0.16 Short Physical Performance Battery points.

The joint models of longitudinal trajectories of physical function and waitlist mortality showed that longitudinal trajectory of the following physical function measures were associated with increased waitlist mortality: grip (HR = 0.89; 95% CI, 0.83-0.95), gait (HR = 0.72; 95% CI, 0.62-0.84), chair stands (HR = 1.17; 95% CI, 1.09-1.25) and Short Physical Performance Battery less than 10 (HR = 1.45; 95% CI, 1.15-2.2), even after adjusting for MELD-Na, albumin, hepatocellular carcinoma and baseline physical function.

“For those awaiting liver transplantation, these data can compel patients with rapid physical decline — out of proportion to a rise in their MELD score — to seek live donor liver transplant or accept higher-risk donor livers,” the researchers concluded. – by Melinda Stevens

Disclosure: Lai reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.