1049 The Palliative Performance Scale Among Patients Evaluated for Liver Transplantation

Abstract

INTRODUCTION: Patients being evaluated for liver transplantation (LT) often suffer from poor health-related quality of life. While several quality measures exist for palliative care in cancer patients, there are limited cirrhosis-specific palliative care tools. The Palliative Performance Scale (PPS) is a prognostication tool that measures a patient’s functional status based on ability to ambulate, activity level, evidence of disease, self-care abilities, oral intake, and level of consciousness, where a patient with a PPS of 100% is functionally healthy. We aim to observe how PPS at initial transplant evaluation relates to patient demographics, decompensation, and transplant outcomes to establish its potential role in the LT population. METHODS: We examined the records of patients who completed LT evaluation at our mid-size liver transplant center. Between March and December 2018, we calculated the PPS as a part of new outpatient LT evaluations. Descriptive statistics were used to evaluate relationships between patient PPS scores and MELD, disease characteristics, and outcomes. RESULTS: Forty-nine patients completed LT evaluation, of which 71% (N = 35) were male and 80% (N = 39) were white. The average age at the time of evaluation was 63. The most common etiology of cirrhosis was NASH (35%, N = 17), followed by alcohol (29%, N = 14), and HCV (25%, N = 12). Among the three most common etiologies, those with alcoholic cirrhosis had the lowest average PPS scores (76), patients with HCV had the highest (90). During the study period, 8 patients were transplanted. Their average PPS at the time of evaluation was 76 compared to 80 among those who were not transplanted. When compared to men, women had a higher MELD (15 vs 13), and lower PPS (74 vs 82). The rates of decompensation among patients with a PPS of 100, 80, and 70 were 55%, 86%, and 93%, respectively. CONCLUSION: This pilot study examines the utility of PPS for patients undergoing LT evaluations, and several trends were elucidated warranting further evaluation. There was not a clear linear relationship between MELD and PPS, indicating that patients with end-stage liver disease have a variable symptom burden even at advanced disease states. The functional status of patients appeared to vary significantly between etiology, gender, and transplantation. Importantly, our data suggests that patients with documented decompensations had lower PPS, indicating a possible role for the PPS to better characterize the functional status and disease burden of these patients.