Abstract 16289: Functional Status Improves Following Heart Transplantation for Most Patients and Functional Status at One Year Predicts Five-Year Survival

Abstract

Introduction: Heart transplantation is a critical treatment for end-stage heart disease, with the goal of improving both length and quality of life. We investigated predictors of functional status improvement following transplant and the impact of functional status at 1 year on survival. Methods: We used data from the Scientific Registry of Transplant Recipients on 34,649 U.S. adults who received a heart transplant from Jan. 2006 - Jul. 2020. Functional status was measured using the Karnofsky Performance Scale (KPS; 0-100%). Linear regression with stepwise selection was used to identify predictors of change in KPS from listing to transplant, and from transplant to 1 and 5 years post-transplant. Kaplan Meier curves with log-rank testing was used to compare 5-year survival between patients with poor (≤50%) versus non-poor (>50%) KPS at 1 year. Results: Mean KPS was low at listing (47.9%, SD 22.4%) and discharge following transplant (45.6%, SD 24.1%). At 1-year post-transplant, the mean KPS increased to 85.8% (SD 17.7%), which was stable at 5 years (Figure). There was a small difference in KPS at 1 and 5 years based upon KPS at listing (p<0.0001). After adjusting for KPS at transplant and transplant center, predictors of the magnitude of KPS change from transplant to 1 year included insurance type, diabetes, hypertension, prior cardiac surgery, smoking, “1A” waitlist priority, and hospitalization status. Predictors of KPS change from transplant to 5 years included insurance type, diabetes, ventricular assist device use, prior cardiac surgery, sex, and age. Only 5.5% of patients had poor KPS (≤50%) at 1 year. Of these patients, 5-year survival was significantly lower at 72.9% compared to 88.3% among patients with KPS>50% at 1 year (p<0.0001). Conclusions: Functional status is an important outcome following heart transplant and impacts survival. Most patients alive at 1 year have excellent KPS but clinical and social interventions may help optimize KPS among at-risk patients.