Disease severity, disease aetiology and nutritional status are important determinants of outcome in patients with cirrhosis. Functional decline, reflected by health-related quality of life (HRQOL), mental health, and degrees of disability and frailty may also play an important role. However, it is unclear whether these factors influence outcome after liver transplantation. This study aimed to assess the predictive validity of indices of functional decline in determining transplantation outcome in patients with cirrhosis.Methods
Twenty-eight consecutive patients (mean [range] age 52 [29–66] yr; 75% men; four (14.3%) alcohol–related; mean MELD 13.2 [7–30]) transplanted for end stage liver disease/HCC were included. All were assessed pre-transplantation, as follows: disease severity: MELD and Child Pugh (CP); nutritional status: The Royal Free Hospital-Nutritional Prioritising Tool; HRQOL: Chronic Liver Disease Questionnaire and Euro Quol-5 Dimension Tool; mental health: Beck Anxiety and Depression Indices; disability: Activities (ADL) and Independent Activities of Daily Living (IADL); and frailty: Clinical Frailty Scale, Short Physical Performance Battery and Fried Frailty Criteria plus two composite instruments, the Bristol Prognostic Index and Karnofsky Age MELD Model. Variables associated with the primary outcome (death/retransplantation) were identified using Cox regression analysis. Variables associated with secondary outcomes, including the total units of blood transfused and the length of hospital stay, were identified using linear regression analysis.Results
Patients were followed for a mean of 143 [3–326] days; two (7.1%) died and four (14.3%) were retransplanted. IADL was the only tool significantly associated with mortality in this cohort. Each unit increase in the IADL (decreasing frailty) was associated with a 45% decrease in mortality after adjustment for MELD (Hazard Ratio (HR) 0.55, 95% CI, 0.33–0.92). The total mean LOHS was 28 [7–112] days. The CP score was significantly associated with LOHS (F(1, 25)=6.01, p=0.02, R2=0.19); each unit increase in CP was associated with an increase in LOHS of 6.5 days. The mean units of blood transfused was 46 [3–178]; The amount transfused increased by 11.33 (p=0.03) and 4.2 (p=0.01) units for each unit increase in CP and MELD scores respectively.Conclusions
Disease severity and functional decline, characterised by the IADL score are significantly associated with short to medium term transplant outcomes in this cohort. Longer-term follow is required to validate these Results.