Among U.S. Adults Undergoing Liver Transplantation, African Americans and Hispanics Have Significantly Worse Functional Status at Time of Liver Transplant

Abstract

Introduction: While poor functional status correlates with worse post-liver transplantation (LT) outcomes, it is unclear if certain groups have disparately worse functional status at time of LT. We aim to evaluate sex-, age-, and ethnicity-specific differences in functional status at LT and its impact on post-LT survival. Methods: Based on 2005-2016 United Network for Organ Sharing data, functional status at LT, determined using Karnofsky Performance Status score (KPSS 1: functional status 80-100%, KPSS 2: 60-70%, KPSS 3: 40-50%, KPSS 4: 10-30%), was compared by sex, age, and ethnicity using chi-square testing. The interactions of sex, age, ethnicity, and KPSS on post-LT survival were evaluated with Kaplan Meier methods and multivariate logistic regression models (adjusted for age, sex, race/ethnicity, liver disease etiology, MELD score, insurance, transplant year, and hepatocellular carcinoma (HCC). Results: Among 66,397 LT recipients, 68% were male, 72% non-Hispanic white, 22% had concurrent HCC. Compared to men, women were more likely to have worse KPSS at LT (KPSS 4: 28.0% vs. 22.8% (males), p> 70), 21.9% (age 60-69), 23.7% (age 50-59) vs. 29.9% (age<50), p<0.01 for all). Compared to Caucasians, significantly worse KPSS at LT was seen in Hispanics (KPSS 4: 31.7% vs. 23.0%, p<0.001) and African Americans (AA) (KPSS 4: 25.4% vs. 23.0%, p<0.01). Worse KPSS at LT was associated with lower 5-year post-LT survival in males (69.8% (KPSS 4) vs. 78.7% (KPSS 1)) and females (71.2% (KPSS 4) vs. 80.4% (KPSS 1)), p<0.01 for both. Similar trends were seen in all age and race/ethnic groups (5-year survival: Caucasians, 70.3% (KPSS 4) vs. 79.8% (KPSS 1); African Americans, 65.8% (KPSS 4) vs. 70.4% (KPSS 1); Hispanics, 72.1% (KPSS 4) vs. 78.8% (KPSS 1); Asians, 75.0% (KPSS 4) vs. 84.1% (KPSS 1), p<0.01 for all). On multivariate regression, compared to Caucasians, post-LT mortality was higher in AA (HR 1.31; 95% CI 1.23-1.39) and lower in Hispanics (HR 0.87; 95% CI 0.82-0.93), p<0.001 for both. Compared to patients age <50, increasing age at LT correlated with higher post-LT mortality. Conclusion: Among U.S. adults undergoing LT, African Americans and Hispanics had significantly worse KPSS at time of LT compared to Caucasians. Women and younger adults also had worse KPSS. These findings are concerning given that worse functional status correlates with lower post-LT survival.1018 Figure 1 No Caption available.