S. Kulkarni2, H. Chen4, D. A. Josbeno5, A. Schmotzer1,6, C. Hughes1, A. Humar1, V. Rachakonda1,3, M. A. Dunn1,3, A. D. Tevar1 3University Of Pittsburgh,Division Of Gastroenterology, Hepatology & Nutition / Dept. Of Medicine,Pittsburgh, PA, USA 4Department Of Medicine,University Of Pittsburgh Medical Center,Pittsburgh, PA, USA 5Department Of Physical Therapy,University Of Pittsburgh Medical Center,Pittsburgh, PA, USA 6Division Of Gastroenterology, Hepatology & Nutrition,University Of Pittsburgh Medical Center,Pittsburgh, P, USA 1Thomas E. Starzl Transplantation Institute,Dept. Of Surgery / University Of Pittsburgh,Pittsburgh, PA, USA 2Department Of Surgery,University Of Pittsburgh Medical Center,Pittsburgh, PA, USA
Introduction: Frailty scores have been shown to effectively predict perioperative surgical risk. In this light, gait speed has been validated as a reproducible metric of patients functional status and facility with activities of daily living. Studies have also validated its role in predicting morbidity and long-term survival. The 5-Meter Walk Test (5MWT), which measures patients’ self-selected gait speed, is a pragmatic and reproducible clinical test that can be easily conducted in an outpatient setting. Grip strength is another practical outpatient test that can be measured with a hand dynamometer and measures dominant hand isometric grip force in pounds. We propose that the 5MWT and grip strength measurement can accurately capture frailty in liver transplant listed patients, and more specifically, can predict liver transplant waitlist dropout.
Methods: A retrospective analysis was done of patients undergoing outpatient liver transplant evaluation and successful listing at UPMC between 7/2013 and 7/2016. All of these patients had an averaged 5MWT score calculated after performing the test three times with a one-minute rest in between walks. In addition, each patient had dominant arm grip strength measured and recorded with a hydraulic hand dynamometer. Patients with waitlist dropout due to progression of HCC were excluded from analysis. Patient demographics, transplant evaluation data, and outcomes on the waitlist were examined. Statistical analysis was performed using student t-test and chi-square analysis.
Results: A total of 197 liver transplant listed patients evaluated as outpatients were reviewed. The patients had an average age of 57.1 years (range 20 to 74) and were predominantly white (90.4%). Patients’ most common etiology of liver disease was HCV, 64 (32.5%) of patients had a diagnosis of HCC, 14 (7.1%) of patients had a previous liver transplant, and average MELD score upon listing was 16.0. Of the 197 patients, 38 (19.3%) were ultimately dropped from the waitlist due to non-HCC related reasons. Grip Strength was predictive of waitlist dropout (46.14 lbs vs. 59.6 lbs; p<0.005). In addition, 5MWT times were found to be an independent predictor of waitlist dropout (0.92 m/s vs. 1.03 m/s; p < 0.005).
Conclusion: The 5MWT and grip strength have been shown to accurately measure frailty, and we show that both independently predict waitlist dropout among liver transplant listed patients. The 5MWT and grip strength should be considered valuable tools in the evaluation and maintenance of end stage liver patients listed for transplant.