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Physical Performance Decline During the Early Posttransplantation Period Affects Survival After Living Donor Liver Transplantation

Authors
 Deok-Gie Kim  ;  Shin Hwang  ;  Kwang-Woong Lee  ;  Gyu-Seong Choi  ;  Young Kyoung You  ;  Je Ho Ryu  ;  Bong-Wan Kim  ;  Yang Won Nah  ;  Dong-Sik Kim  ;  Jai Young Cho  ;  Koo Jeong Kang  ;  Geun Hong  ;  Hee Chul Yu  ;  Man Ki Ju  ;  Suk-Won Suh  ;  Kwan Woo Kim  ;  Dongho Choi  ;  Jaehong Jeong  ;  Soo Jin Na Choi  ;  Ju Ik Moon  ;  Jae Geun Lee  ;  Myoung Soo Kim  ;  Donglak Choi  ;  Dong Jin Joo 
Citation
 TRANSPLANTATION, Vol.107(7) : 1545-1553, 2023-07 
Journal Title
TRANSPLANTATION
ISSN
 0041-1337 
Issue Date
2023-07
MeSH
Graft Survival ; Humans ; Liver Transplantation* / adverse effects ; Living Donors ; Proportional Hazards Models ; Retrospective Studies ; Treatment Outcome
Abstract
Background: Patient physical performance has been emphasized in liver transplant recipients; however, evidence for living donor liver transplantation (LDLT) patients is lacking. This study investigated the impact of physical performance decline during the early posttransplantation period on survival and risk factors for this decline in LDLT recipients.

Methods: From national registry data, 2703 LDLT patients were divided into 2 groups based on the change in their Karnofsky performance status (KPS) between 1 and 6 mo posttransplantation: declined KPS (n = 188) and control (n = 2515). Multivariable analyses were conducted to control for confounders, including posttransplantation complications.

Results: Estimated 5-y patient survival rates were 91.6% in the declined KPS group and 96.3% in the control group, favoring the latter ( P = 0.003). The survival hazard of KPS decline was significant in a baseline covariates-adjusted Cox model (hazard ratio [HR], 2.60; 95% confidence interval [CI], 1.37-4.95) and an adjusted model accounting for posttransplantation complications (HR, 3.38; 95% CI, 1.70-6.72). In subgroup analyses, KPS decline independently reduced survival in patients without complications (HR, 3.95; 95% CI, 1.67-9.34), and the trend was similar in patients with complications, although significance was marginal (HR, 3.02; 95% CI, 0.98-9.27). We found that only posttransplantation complications, such as rejection, infection, bile duct complication, and vascular complication, were significant risk factors for KPS decline after LDLT.

Conclusions: Physical performance decline during the early posttransplantation period independently reduced survival rates, and posttransplantation complications were the only significant risk factors for physical performance decline in LDLT recipients.

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Full Text
https://journals.lww.com/transplantjournal/Fulltext/2023/07000/Physical_Performance_Decline_During_the_Early.20
DOI
10.1097/tp.0000000000004517
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Deok Gie(김덕기)
Kim, Myoung Soo(김명수) ORCID logo https://orcid.org/0000-0002-8975-8381
Lee, Jae Geun(이재근) ORCID logo https://orcid.org/0000-0002-6722-0257
Joo, Dong Jin(주동진) ORCID logo https://orcid.org/0000-0001-8405-1531
Joo, Man Ki(주만기) ORCID logo https://orcid.org/0000-0002-4112-7003
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/196000
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