Handgrip strength: A simple and effective tool to predict mortality after liver transplantation.

Abstract

Malnutrition is a widely prevalent yet unrecognized problem of patients with end-stage liver disease (ESLD) awaiting liver transplant (LT). The aim of this study was to ascertain pre-LT nutritional status of adult Asian Indian patients with ESLD including functional deficit (frailty) and determine predictor/s of poor post-LT outcome (futility). A prospective, longitudinal, single-center study which enrolled adults listed for LT between October 2014 and April 2018. Consecutive patients who consented, met the inclusion criteria, and underwent LT were included. The demographic data, nutritional, functional and dietary assessments from evaluation till 1-year-post-LT were documented. Data was analyzed using SPSS-25.0. One hundred and fifty two patients, aged 50.6±8.3 years, predominantly men (82.9%), underwent LT (predominantly deceased donor LT (DDLT) 78.3%). One hundred and thirty five patients (88.8%) were discharged alive after LT. The presence of pre-LT hepatorenal syndrome (HRS), baseline handgrip strength (HGS) <20kg and SGA rated malnutrition, 1st-pre-LT follow-up HGS (<20kg), non-achievers of ≥80% targeted energy and protein intake were associated with increasing 1-year-post-LT mortality rate (p<0.05). A cut-off of 18.15kg HGS was found to predict 1-year-post-LT survival, with optimal sensitivity (77.4); specificity (43.5), and an area under a receiver operating curve (ROC) of 0.676 (p=0.008), with a 95% CI [0.545-0.806]. Step-wise binary logistic regression indicated that non-achievers of ≥80% targeted protein at 1st-pre-LT follow-up and baseline HGS (<18.15kg) are two independent factors that predict 1-year-post-LT survival with an odds ratio of 13.168 and 7.041, respectively. A cut-off of 18.15kg baseline HGS before LT was found to be a significant predictor of poor survival in Asian Indian patients with ESLD. It was also instrumental in identifying patients at risk and helping to target intensive nutritional intervention therapy. Patients in whom ≥80% pre-LT nutritional goal was successfully achieved during the waiting period had an improved 1-year-post-LT survival.