Department of Medicine, Division of Gastroenterology and Hepatology, California Pacific Medical Center, San Francisco.
Division of Gastroenterology and Hepatology, Stanford Health Care, Palo Alto.
J Clin Gastroenterol. 2019 Oct;53(9):e392-e399. doi: 10.1097/MCG.0000000000001187.
To evaluate the impact of Karnofsky Performance Status score (KPSS) at the time of liver transplantation (LT) on post-LT survival.
While the Model for End-Stage Liver Disease (MELD) score is used to prioritize individuals for LT, it does not specifically incorporate functional status into patient assessment for LT.
Using 2005 to 2016 United Network for Organ Sharing data, all adults (age 18 y and above) undergoing LT were identified. The association of KPSS at the time of LT (KPSS 1: functional status 80% to 100%, KPSS 2: 60% to 70%, KPSS 3: 40% to 50%, KPSS 4: 10% to 30%) with post-LT survival was evaluated using Kaplan-Meier methods and adjusted multivariate logistic regression models.
Among 66,397 LT recipients (68% male, 72% non-Hispanic white, 22% hepatocellular carcinoma, median age: 55 to 57), women were more likely to be KPSS 4 at the time of LT compared with men (27.95% vs. 22.79%; P<0.001) and African Americans (25.43% vs. 23.03%; P<0.001) and Hispanics (31.69% vs. 23.03%; P<0.001) were more likely to be KPSS 4 than non-Hispanic whites. Worse KPSS at LT correlated with higher post-LT mortality [compared with KPSS 1: Hazard Ratio (HR) for KPSS 2: 1.16, 95% confidence interval (CI): 1.10-1.22; HR for KPSS 3: 1.40; 95% CI: 1.32-1.49; HR for KPSS 4: 1.67; 95% CI: 1.55-1.79]. This increased mortality seen with worse KPSS was observed among all liver disease etiologies and in patients with and without hepatocellular carcinoma.
Worse functional status at the time of LT is strongly associated with higher risk of mortality following LT, emphasizing the importance of optimizing performance status in the preoperative period.
评估肝移植（LT）时 Karnofsky 表现状态评分（KPSS）对 LT 后生存的影响。
虽然终末期肝病模型（MELD）评分用于优先考虑 LT 患者，但它并未将功能状态具体纳入 LT 患者评估中。
使用 2005 年至 2016 年美国器官共享网络数据，确定所有接受 LT 的成年人（年龄 18 岁及以上）。使用 Kaplan-Meier 方法和调整后的多变量逻辑回归模型评估 LT 时 KPSS（KPSS1：功能状态 80%至 100%，KPSS2：60%至 70%，KPSS3：40%至 50%，KPSS4：10%至 30%）与 LT 后生存的关系。
在 66397 名 LT 受者中（68%为男性，72%为非西班牙裔白人，22%为肝细胞癌，中位年龄为 55 至 57 岁），女性在 LT 时更可能处于 KPSS4 状态，而男性则更可能处于 KPSS4 状态（27.95%比 22.79%；P<0.001），非西班牙裔黑人（25.43%比 23.03%；P<0.001）和西班牙裔（31.69%比 23.03%；P<0.001）。LT 时较差的 KPSS 与更高的 LT 后死亡率相关[与 KPSS1 相比：KPSS2 的危险比（HR）为 1.16，95%置信区间（CI）为 1.10-1.22；KPSS3 的 HR 为 1.40；95%CI：1.32-1.49；KPSS4 的 HR 为 1.67；95%CI：1.55-1.79]。在所有肝病病因和患有或不患有肝细胞癌的患者中，KPSS 越差，死亡率越高。
LT 时功能状态越差与 LT 后死亡率升高密切相关，这强调了术前优化表现状态的重要性。
