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Functional status, healthcare utilization, and the costs of liver transplantation
Author(s) -
Serper Marina,
Bittermann Therese,
Rossi Michael,
Goldberg David S.,
Thomasson Arwin M.,
Olthoff Kim M.,
Shaked Abraham
Publication year - 2018
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.14576
Subject(s) - medicine , decile , cohort , liver transplantation , transplantation , liver disease , statistics , mathematics
The Model for End‐Stage Liver Disease ( MELD ) score predicts higher transplant healthcare utilization and costs; however, the independent contribution of functional status towards costs is understudied. The study objective was to evaluate the association between functional status, as measured by Karnofsky Performance Status ( KPS ), and liver transplant ( LT ) costs in the first posttransplant year. In a cohort of 598 LT recipients from July 1, 2009 to November 30, 2014, multivariable models assessed associations between KPS and outcomes. LT recipients needing full assistance ( KPS 10%‐40%) vs being independent ( KPS 80%‐100%) were more likely to be discharged to a rehabilitation facility after LT (22% vs 3%) and be rehospitalized within the first posttransplant year (78% vs 57%), all P < .001. In adjusted generalized linear models, in addition to MELD ( P < .001), factors independently associated with higher 1‐year post‐ LT transplant costs were older age, poor functional status ( KPS 10%‐40%), living donor LT , pre‐ LT hemodialysis, and the donor risk index (all P < .001). One‐year survival for patients in the top cost decile was 83% vs 93% for the rest of the cohort (log rank P < .001). Functional status is an important determinant of posttransplant resource utilization; therefore, standardized measurements of functional status should be considered to optimize candidate selection and outcomes.