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Karnofsky performance status predicts liver transplant survival

The Karnofsky performance status independently predicted graft and patient survival before and after liver transplantation, according to recently published data.

“The Karnofsky performance status (KPS) has been used for almost 70 years in clinical practice as a subjective ‘eyeball’ assessment of the overall performance status of patients,” Paul J. Thuluvath, MD, from the Johns Hopkins University School of Medicine in Baltimore, Maryland, and colleagues wrote. “We have shown that low KPS scores are associated with worse outcomes after LT. Moreover, the absence of improvement on KPS scores is associated with poor survival especially in those with low KPS at the time of LT.”

The study comprised 50,417 patients who were listed for liver transplantation in the UNOS system between Jan. 1, 2006, and Sept. 30, 2016. At the time of LT, 15,103 patients had a low KPS score, 22,183 had intermediate scores and 13,131 had high scores. Patients with low and intermediate scores had worse graft and patient survival probabilities.

Multivariate analysis showed that poor performance status at the time of transplantation correlated with lower graft and patient survival among those with low (HR = 1.38; 95% CI, 1.31-1.46) and intermediate KPS scores (HR = 1.17; 95% CI, 1.12-1.22). Similarly, patient failure correlated significantly with the low (HR = 1.43; 95% CI, 1.35-1.52) and intermediate score groups (HR = 1.18; 95% CI, 1.13-1.24).

Other factors that negatively predicted graft and patient survival included older age (HR = 1.02), hepatic encephalopathy (HR = 1.07; 95% CI, 1.03-1.11), donor risk index (HR = 1.3; 95% CI, 1.25-1.35) and liver disease etiology.

After liver transplantation, 1-year survival was 33% among patients with no improvement in KPS scores between 3 months and 12 months posttransplant compared with 91% to 99% in those who had improved scores.

Compared with patients with a KPS improvement of 50% or more, risk factors for non-improvement in KPS posttransplant included older age (OR = 1.02; 95% CI, 1.01-1.03), total bilirubin less than 12 mg/dL at transplant (OR = 1.27; 95% CI, 1.02-1.59), MELD less than 30 (OR = 1.28; 95% CI, 1.03-1.59), serum albumin at transplant (OR = 0.84; 95% CI, 0.75-0.95), presence of hepatitis C (OR = 1.5; 95% CI, 1.22-1.84) or hepatocellular carcinoma (OR = 1.46; 95% CI, 1.16-1.83), and acute rejection episodes between transplant and hospital discharge (OR = 1.63; 95% CI, 1.14-2.35).

“The improvement in KPS scores after LT reached a plateau at one year and thereafter there was no significant improvement,” the researchers wrote. “Multidisciplinary approaches to improve performance status should be tested in a prospective manner to determine whether survival outcomes could be improved in LT candidates.” – by Talitha Bennett.

Disclosure: The authors report no relevant financial disclosures.