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Impaired functional capacity in potential liver transplant candidates predicts short‐term mortality before transplantation
Author(s) -
Ow Maggie M. G.,
Erasmus Paul,
Minto Gary,
Struthers Richard,
Joseph Moby,
Smith Aileen,
Warshow Usama M.,
Cramp Matthew E.,
Cross Tim J. S.
Publication year - 2014
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.23907
Subject(s) - medicine , liver transplantation , receiver operating characteristic , transplantation , perioperative , liver disease , confidence interval , cardiorespiratory fitness , univariate analysis , area under the curve , anaerobic exercise , multivariate analysis , surgery , cardiology , physical therapy
Liver transplantation (LT) is a lifesaving treatment. Because of the shortage of donor organs, some patients will not survive long enough to receive a transplant. The identification of LT candidates at increased risk of short‐term mortality without transplantation may affect listing decisions. Functional capacity, determined with cardiopulmonary exercise testing (CPET), is a measure of cardiorespiratory reserve and predicts perioperative outcomes. This study examined the association between functional capacity and short‐term survival before LT and the potential for CPET to predict 90‐day mortality without transplantation. A total of 176 patients who were assessed for nonacute LT underwent CPET. Ninety days after the assessment, 10 of the 164 patients who had not undergone transplantation were deceased (mortality rate = 6.1%). According to a comparison of survivors and nonsurvivors, the Model for End‐Stage Liver Disease score, UK Model for End‐Stage Liver Disease (UKELD) score, age, anaerobic threshold, and peak oxygen uptake (VO 2 ) were significant univariate predictors of 90‐day mortality without transplantation, but only the UKELD score and peak VO 2 retained significance in a multivariate analysis. The mean peak VO 2 was significantly lower for nonsurvivors versus survivors (15.2 ± 3.3 versus 21.2 ± 5.3 mL/minute/kg, P < 0.001). According to a receiver operating characteristic (ROC) curve analysis, peak VO 2 performed well as a diagnostic test (area under the ROC curve = 0.84, 95% confidence interval = 0.76‐0.92, sensitivity = 0.90, specificity = 0.74, P < 0.001). The optimal cutoff value for predicting mortality was ≤17.6 mL/minute/kg. The positive predictive value of a peak VO 2 ≤ 17.6 mL/minute/kg for 90‐day mortality was greatest for patients with high UKELD scores: 38% of the patients with a UKELD score ≥ 57 and a peak VO 2 ≤ 17.6 mL/minute/kg died, whereas only 6% of the patients with a UKELD score ≥ 57 and a peak VO 2 > 17.6 mL/minute/kg died ( P = 0.03). In conclusion, patients assessed for LT with an impaired functional capacity have poorer short‐term survival; this is particularly true for individuals with worse liver disease severity. Liver Transpl 20:1081–1088, 2014 . © 2014 AASLD.