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Disability in patients with end-stage liver disease: Results from the functional assessment in liver transplantation study.

Publication ,  Journal Article
Samoylova, ML; Covinsky, KE; Haftek, M; Kuo, S; Roberts, JP; Lai, JC
Published in: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
March 2017

Cirrhosis leads to sarcopenia and functional decline that can severely impact one's ability to function at home and in society. Self-reported disability scales to quantify disability-Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL)-are validated to predict mortality in older adults. To evaluate disability in liver transplantation (LT) candidates and quantify its impact on outcomes, consecutive outpatients ≥18 years listed for LT with laboratory Model for End-Stage Liver Disease scores of ≥12 at a single high-volume US LT center were assessed for ADLs and IADLs during clinic visits. Multivariate competing risk models explored the effect of disabilities on wait-list mortality (death or delisting for illness). Of 458 patients, 36% were women, median (interquartile range [IQR]) age was 60 years (IQR, 54-64 years), and initial Model for End-Stage Liver Disease-Sodium (MELD-Na) was 17 (IQR 14-20). At first visit, 31% had lost ≥ 1 ADL, and 40% had lost ≥ 1 IADL. The most prevalent ADL deficits lost were continence (22%), dressing (12%), and transferring (11%); the most prevalent IADLs lost were shopping (28%), food preparation (23%), and medication management (22%). After adjustment for age, MELD-Na, and encephalopathy, dressing (subdistribution hazard ratio [SHR], 1.7; 95% confidence interval [CI], 1.0-2.8; P = 0.04), toileting (SHR, 1.9; 95% CI, 1.1-3.5; P = 0.03), transferring (SHR, 1.9; 95% CI, 1.1-3.0; P = 0.009), housekeeping (SHR, 1.8; 95% CI, 1.2-3.0; P = 0.009), and laundry (SHR, 2.2; 95% CI, 1.3-3.5; P = 0.002) remained independent predictors of wait-list mortality. In conclusion, ADL/IADL deficits are common in LT candidates. LT candidates would benefit from chronic disease management programs developed to address the impact of cirrhosis on their daily lives. Liver Transplantation 23 292-298 2017 AASLD.

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Published In

Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society

DOI

EISSN

1527-6473

ISSN

1527-6465

Publication Date

March 2017

Volume

23

Issue

3

Start / End Page

292 / 298

Related Subject Headings

  • Waiting Lists
  • Surgery
  • Sodium
  • Severity of Illness Index
  • Self Report
  • Sarcopenia
  • Risk Assessment
  • Prospective Studies
  • Proportional Hazards Models
  • Middle Aged
 

Citation

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Samoylova, M. L., Covinsky, K. E., Haftek, M., Kuo, S., Roberts, J. P., & Lai, J. C. (2017). Disability in patients with end-stage liver disease: Results from the functional assessment in liver transplantation study. Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 23(3), 292–298. https://doi.org/10.1002/lt.24684
Samoylova, Mariya L., Kenneth E. Covinsky, Marta Haftek, Selena Kuo, John P. Roberts, and Jennifer C. Lai. “Disability in patients with end-stage liver disease: Results from the functional assessment in liver transplantation study.Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society 23, no. 3 (March 2017): 292–98. https://doi.org/10.1002/lt.24684.
Samoylova ML, Covinsky KE, Haftek M, Kuo S, Roberts JP, Lai JC. Disability in patients with end-stage liver disease: Results from the functional assessment in liver transplantation study. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. 2017 Mar;23(3):292–8.
Samoylova, Mariya L., et al. “Disability in patients with end-stage liver disease: Results from the functional assessment in liver transplantation study.Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, vol. 23, no. 3, Mar. 2017, pp. 292–98. Epmc, doi:10.1002/lt.24684.
Samoylova ML, Covinsky KE, Haftek M, Kuo S, Roberts JP, Lai JC. Disability in patients with end-stage liver disease: Results from the functional assessment in liver transplantation study. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. 2017 Mar;23(3):292–298.
Journal cover image

Published In

Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society

DOI

EISSN

1527-6473

ISSN

1527-6465

Publication Date

March 2017

Volume

23

Issue

3

Start / End Page

292 / 298

Related Subject Headings

  • Waiting Lists
  • Surgery
  • Sodium
  • Severity of Illness Index
  • Self Report
  • Sarcopenia
  • Risk Assessment
  • Prospective Studies
  • Proportional Hazards Models
  • Middle Aged