Functional status predicts postoperative mortality after liver transplantation

Background Frail patients are more vulnerable to perioperative stressors of liver transplantation (LT). Program Specific Reports, used in transplant center auditing, risk‐adjust for frailty using the Karnofsky Performance Status (KPS) scale. We evaluate the extent to which functional impairment/disability is associated with increased risk of postoperative death. Methods We included 24 505 first‐time LT recipients from the Scientific Registry of Transplant Recipients (2006–2011). We categorized patients as Severe, Moderate, or Normal function/disability using the KPS scale and evaluated risk of 30‐ and 90‐day mortality. Analyses took potential center‐specific differences in KPS measurement protocols into account using hierarchal logistic modeling. Results Over one‐quarter of our population was Severely impaired/disabled, and 30.5% had no functional limitations. Severely and Moderately impaired/disabled patients had 2.56 (95% CI 1.91–3.44) and 1.40 (95% CI 1.10–1.78) times the odds of 30‐day mortality, respectively, after adjusting for key recipient and donor factors. Estimates remained consistent regardless of Model for End‐Stage Liver Disease score, medical condition, or clustering analyses by center. Technical/operative complications and multiorgan failure/hemorrhage were more common causes of death among more Severely disabled patients than in higher functioning groups. Conclusions Pre‐transplant functional status, assessed using the KPS scale, is a reliable predictor of post‐LT mortality in the United States.