Objective Versus Subjective Assessment of Functional Status in Candidates for Liver Transplantation

Abstract

Introductionand aim. Poor functional status is associated with increased mortality in cirrhosis patients awaiting liver transplantation (LT); however, the optimal assessment of functional status remains unknown. This study sought to determine the relationship between 6-minute walk distance (6MWD) and Karnofsky Performance Status (KPS) and their association with waitlist mortality in LT candidates. Material and methodsTwo hundred seventy-eight consecutive patients listed for LT were included. KPS and 6MWD were assessed at the time of evaluation. KPS was recorded as a percentage from 0 to 100, with 0 representing death and 100 representing no presence of disease. Patients were followed from time of listing until transplantation, death, removal from the waitlist or end of the study period. ResultsThe mean KPS and 6MWD were 77.4 ± 13.5 and 323.6 ± 163.9 m, respectively. A mild correlation between 6MWD and KPS was demonstrated (Spearman ρ = 0.4317, P < .0001). KPS was significantly lower in patients with 6MWD < 250 meters (P < .0001). The 6MWD was significantly lower in patients who suffered waitlist mortality (266.1 vs 331.8 m, P = .05). ConclusionIn conclusion, 6MWD is a better predictor of waitlist mortality than KPS score in candidates for LT. The addition of 6MWD as a standard assessment may help to identify patients at risk of dying on the waitlist.