Performance status seems to have an adverse impact on living donor liver transplantation (LDLT) outcomes. In a recent study by Choudhary et al, published in the Journal of Clinical and Experimental Hepatology, data were presented regarding performance status and post-transplantation survival in an LDLT cohort.

The study excluded patients with ABO incompatibility, of pediatric age, with acute liver failure, with hepatocellular carcinoma, and those who had incomplete data. Overall, 260 adults with decompensated cirrhosis who underwent LDLT between January 2016 and March 2018 were included in the study. Performance status was assessed using Karnofsky Performance Score (KPS). The data are depicted as number, mean (SD), or median (25-75 interquartile range [IQR]).

The causes of liver disease included hepatitis B in 33, hepatitis C in 19, alcohol related in 120, nonalcoholic steatohepatitis/cryptogenic in 68, and other etiologies in 20 patients. Mean Childs score was 9.6 ± 1.7, Model for End-Stage Liver Disease (MELD) score was 18.0 ± 5.8, and donor age was 33.4 ± 9.9 years. Forty one recipients died at a median follow-up of 11 months. KPS was 100 in 6 (no deaths), 90 in 53 (2 deaths), 80 in 93 (12 deaths), 70 in 69 (14 deaths), 60 in 26 (8 deaths), and 50 in 13 (5 deaths). The area under the receiver operating characteristic curve of KPS to predict mortality was 0.698, with the best sensitivity (63%) and specificity (67%) obtained at KPS ≤70. There was a significant difference between survivors and nonsurvivors for KPS (77.6 ± 10.9 versus 69.5 ± 10.9), patient’s age (47.8 ± 9.4 versus 51.1 ± 11.7), postoperative infections (53.8% versus 85.3%), and need of packed red cells transfusion. According to the multivariate analysis (Cox proportional-hazard), key predictors of mortality included KPS (hazard ratio [HR] = 0.96, 95% CI = 0.93-0.99, P = 0.007), postoperative infections (HR = 2.3, 95% CI = 1.04-5.1, P = 0.038), and recipient age (HR = 1.03, 95% CI = 1.002-1.07, P = 0.039).

Pretransplant performance status was thus shown to be a key predictor of mortality after LDLT.

Source: Choudhary NS, Sonavane A, Saraf N, et al. Poor Performance Status Predicts Mortality After Living Donor Liver Transplantation. J Clin Exp Hepatol. 2020 Jan-Feb;10(1):37-42.