BOSTON – The Karnofsky Performance Status is predictive of 5-year survival among patients with autoimmune-related liver disease who undergo a transplant, based on a retrospective look at more than 6,500 patients.
The analysis also showed that African American patients had a 33% higher mortality risk than non-Hispanic white patients, reported lead author, of California Pacific Medical Center in San Francisco, who presented findings at the annual meeting of the American Association for the Study of Liver Diseases.
According to Dr. Galoosian, previous research has shown that Karnofsky scores are a quick and reliable means of predicting survival with liver transplant, but minimal research has evaluated this clinical tool specifically for patients with autoimmune-related liver diseases, which prompted the present study.
Drawing data from the United Network for Organ Sharing (UNOS; 2004-2017), the investigators evaluated performance status and survival in 6,628 patients who underwent liver transplant for one of three diseases: autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC), or primary biliary cholangitis (PBC). Karnofsky scores were divided into quartiles 1 through 4, from best to worst functional status. The investigators used Kaplan-Meier methods and multivariate Cox proportional hazard ratios to determine relationships between disease etiology, Karnofsky score, and survival; in addition, they evaluated the impact of demographic factors on outcomes.
The population was predominantly non-Hispanic white (73.0%) with smaller proportions of African American (13.4%) and Hispanic patients (11.5%). Of the three diseases, PBC was most common (38.2%), followed by PSC (32.1%), then AIH (29.7%).
Across all etiologies, Karnofsky status was significantly associated with survival; a score of 4 came with a 90% increased risk of posttransplant death, compared with a score of 1. Patients with AIH were most likely to have poor pretransplant functional status, as 39.1% of these patients had a Karnofsky score of 4, compared with 31.9% of patients with PSC and 29.0% of patients with PBC. AIH was also associated with a significantly higher risk of posttransplant death; relative risks for PSC and PBC were 20% and 17% lower, respectively.
Five years after surgery, 84.9% of AIH patients with a Karnofsky score of 1 were alive, compared with 76.1% of patients who had a score of 4. A similar association with functional status was found for PSC (84.9% vs. 75.4%), while PBC had a narrower survival margin (88.7% vs. 86.9%).
Analysis also revealed a wide survival gap between patients of different ethnic backgrounds. Compared with white patients, African American patients had a 33% higher risk of dying on the wait list or after transplant.
“[This gap] could reflect a multitude of issues, one being delayed referral to a hepatologist and being listed for transplant much later, so [patients] tend to be more sick,” Dr. Galoosian said.
He also offered some insight into clinical relevance.
“A broader implication of this research could be in the primary care setting,” Dr. Galoosian said. “[Clinicians need to be] aware that someone’s functional status has a broader impact on their health and be aware that ethnic minorities need to be more vigilantly up to date on their health care maintenance and more vigilantly connected to social workers if needed, in terms of getting the resources that they need to help break the [chain] of worse outcomes.”
The investigators disclosed relationships with Gilead, Salix, and AbbVie.
SOURCE: Galoosian A et al. The Liver Meeting 2019. .