Kulkarni S S, Chen H, Josbeno D A, Schmotzer A, Hughes C, Humar A, Sood P, Rachakonda V, Dunn M A, Tevar A D
Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Transplant Proc. 2019 Apr;51(3):794-797. doi: 10.1016/j.transproceed.2019.01.030. Epub 2019 Jan 9.
Frailty measures can predict perioperative surgical risk in liver transplant patients. The 5-meter walk test (5MWT) and hand grip strength (HGS) are easy and reproducible frailty measures. We hypothesized that they could capture frailty in liver transplant listed patients and would be associated with dropping out of the waiting list.
We conducted a retrospective analysis of patients undergoing outpatient liver transplant listing at the University of Pittsburgh Medical Center from 2013 to 2016. We compared demographics, baseline laboratory markers, 5MWT, and HGS between patients who were dropped from the waiting list for medical reasons and those who remained or were successfully transplanted. Bivariate statistical analysis was performed using Fisher exact or χ tests.
We reviewed 197 patients listed for liver transplant. Average age was 57.1 years (range 20-74), and patients were predominantly white (90.4%). Patients' most common etiology of liver disease was hepatitis C (32.5%), 14 (7.1%) had a previous liver transplant, and average Model for End-Stage Liver Disease score upon listing was 16.0. Of the cohort, 38 (19.3%) were ultimately dropped from the waitlist due to non-hepatocellular carcinoma-related reasons. Patients dropped from the waiting list had weaker HGS (46.14 lb vs 59.6 lb; P < .005) and slower 5MWT speed (5MWT: 0.92 m/s vs 1.03 m/s; P < .005).
The 5MWT and HGS can easily measure frailty in patients being evaluated for liver transplant. These tests are associated with waiting list dropout, indicating that they can be valuable tools in the evaluation of these patients.
衰弱指标可预测肝移植患者的围手术期手术风险。5米步行试验（5MWT）和握力（HGS）是简便且可重复的衰弱指标。我们假设它们能够反映列入肝移植等待名单患者的衰弱情况，并与退出等待名单相关。
我们对2013年至2016年在匹兹堡大学医学中心接受门诊肝移植评估的患者进行了回顾性分析。我们比较了因医疗原因从等待名单中退出的患者与仍在等待或成功接受移植的患者的人口统计学特征、基线实验室指标、5MWT和HGS。使用Fisher精确检验或χ检验进行双变量统计分析。
我们回顾了197例列入肝移植等待名单的患者。平均年龄为57.1岁（范围20 - 74岁），患者以白人为主（90.4%）。患者最常见的肝病病因是丙型肝炎（32.5%），14例（7.1%）曾接受过肝移植，列入等待名单时终末期肝病模型评分平均为16.0。在该队列中，38例（19.3%）最终因非肝细胞癌相关原因从等待名单中退出。从等待名单中退出的患者握力较弱（46.14磅对59.6磅；P <.005），5MWT速度较慢（5MWT：0.92米/秒对1.03米/秒；P <.005）。
5MWT和HGS能够轻松测量接受肝移植评估患者的衰弱情况。这些测试与退出等待名单相关，表明它们在评估这些患者时可能是有价值的工具。
