The impact of functional status on post-liver transplant outcomes in acute-on-chronic liver failure

Abstract

Background and aims

Acute-on-Chronic Liver Failure (ACLF) is a severe condition where liver transplantation is often the only definitive treatment. Previous studies have shown an influence of functional status on post-transplant outcomes in patients with advanced chronic liver disease. However, the impact of functional status on outcomes in an ACLF cohort is largely unknown.

Methods

The United Network for Organ Sharing (UNOS) Standard Transplant Analysis and Research (STAR) Database was utilized to study LT patients between 1987 and 2019. Patients were categorized by ACLF grades and further divided within each grade based on their level of assistance—no, some, or total—using KPS scores. The primary outcomes assessed were graft failure and all-cause mortality post-transplant. The secondary outcomes assessed were mortality secondary to specific organ system failures.

Results

Patients without ACLF requiring some (aHR 1.10, 95 %CI 1.04–1.17, p = 0.002) or total assistance (aHR 1.32, 95 %CI 1.22–1.43, p < 0.001) showed increased risk of all-cause mortality. Those needing total assistance also faced a higher risk of graft failure (aHR 1.34, 95 %CI 1.13–1.58, p < 0.001). However, functional status did not significantly impact post-transplant outcomes across all ACLF grades.

Conclusion

Functional status was not a significant predictor of post-transplant outcomes in ACLF patients, regardless of ACLF severity. Poor functional scores in multi-organ failure likely reflect acute critical illness rather than baseline frailty.