Karnofsky Performance Status Is Associated with Patient and Graft Survival After Liver Retransplantation

The impact of Karnofsky Performance Status (KPS), a clinical measure of functional status, on liver retransplantation (re-LT) outcomes, is unknown.

We performed a retrospective analysis of the United Network for Organ Sharing database of adults who underwent re-LT from January 1, 2006, to December 3, 2021, to assess the association between KPS and re-LT outcomes.

A total of 3144 re-LT recipients were included (68% male; mean age, 52.5 ± 11.1 years). The mean Model for End-Stage Liver Disease score at re-LT was 27.5 ± 10.6, and the median time between LT and re-LT was 0.30 years. Low KPS (10%-40%) re-LT recipients had a significantly higher risk of mortality (hazard ratio [HR], 1.7; 95% confidence interval [CI], 1.3-2.2; P < .001) and graft failure (HR, 1.5; 95% CI, 1.1-1.9; P = .003) compared to high KPS (80%-100%) re-LT recipients without controlling for other factors. On multivariable analysis, KPS status remained significantly associated with mortality and graft survival. Compared to the high KPS group, the low KPS group had a 1.6-fold higher risk of death (HR, 1.6; 95% CI, 1.2-2.1; P < .01) and a 1.3-fold higher risk of graft failure (HR, 1.3; 95% CI, 1.1-1.8; P = .03). The association between KPS score and re-LT outcomes remained significant regardless of the time between LT and re-LT.

Our findings demonstrate that functional status is a significant predictor of re-LT outcomes and should be carefully assessed when determining re-LT candidacy.