Etiology-Specific Effects of Impaired Functional Status on Liver Transplant Outcomes

Area of Science:

• Hepatology
• Transplant Surgery
• Clinical Prognostics

Background:

• Pre-liver transplant (LT) functional status is a key prognostic factor.
• Limited data exists on how functional status impacts LT outcomes across diverse liver disease etiologies.
• This study investigates functional status's effect on post-LT prognosis stratified by liver disease type.

Purpose of the Study:

• To evaluate the impact of pre-transplant functional status on post-liver transplant outcomes.
• To stratify liver transplant recipients by etiology of liver disease and assess functional status effects within each subgroup.
• To identify specific liver disease etiologies where functional status is a critical predictor of post-transplant prognosis.

Main Methods:

• Utilized the 2005-2019 UNOS STAR database, including 14,290 liver transplant recipients.
• Stratified patients by functional status using the Karnofsky Performance Scale (KPS): no assistance, some assistance, or total assistance.
• Categorized patients into six etiological groups: MASLD, hereditary disorders, hepatitis C, hepatitis B, autoimmune disease (AID), and alcoholic liver disease (ALD).

Main Results:

• Patients with MASLD requiring assistance (some or total) had significantly higher rates of graft failure and all-cause mortality.
• MASLD patients needing total assistance experienced increased mortality from cardiac, infectious, renal, and respiratory causes, as well as graft rejection.
• Hereditary liver disease recipients needing some assistance showed a lower incidence of all-cause mortality; however, hepatitis C, AID, and ALD recipients with total assistance had higher mortality.

Conclusions:

• Patients with MASLD cirrhosis exhibit the poorest post-transplant outcomes, indicating high vulnerability.
• Poor functional status did not significantly correlate with adverse outcomes in patients with end-stage liver disease from hepatitis B or hereditary causes.
• The Karnofsky Performance Scale (KPS) may have limited applicability across all liver transplant recipient etiological subgroups.