Early Liver Function Parameters Predict Independent Walking Ability After Living Donor Liver Transplantation

Background and Objectives: Postoperative physical recovery, particularly the acquisition of independent ambulation, is a critical milestone in rehabilitation following living donor liver transplantation (LDLT). Although liver function markers are conventionally used to assess hepatic physiology, emerging evidence has suggested their potential role as prognostic indicators of physical performance. Materials and Methods: This study investigated the association between liver function parameters at the initiation of postoperative physical therapy (total bilirubin [T-Bil], aspartate aminotransferase [AST], and alanine aminotransferase [ALT]) and the independent walking ability of 63 patients who underwent LDLT. A logistic regression model was constructed using these variables, and a receiver-operating characteristic (ROC) curve analysis was performed to evaluate its discriminative performance. Predicted probabilities of each patient were calculated, and the optimal cutoff value was determined based on the Youden Index. Results: The multivariate logistic regression model demonstrated a statistically significant association between liver function markers and the ambulation status of a cohort of 63 patients. The ROC curve analysis yielded an area under the ROC curve (AUC) of 0.8416 (95% confidence interval [CI]: 0.715-0.968), indicating strong predictive performance. The optimal cutoff value was 0.865, with sensitivity and specificity of 74.1% and 88.9%, respectively. The bootstrap CI for sensitivity at this threshold ranged from 0.6111 to 0.8519. The Hosmer-Lemeshow test indicated good model fit (p = 0.363), and the correct classification rate was 87.3%. Conclusions: Liver function test results may be indicators of hepatic dysfunction as well as functional biomarkers that could predict ambulatory outcomes following LDLT. This predictive model may enhance early clinical decision-making regarding rehabilitation and discharge planning. Future prospective studies should be performed to validate the generalizability of these results to broader clinical contexts.