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8. Loneliness in adults awaiting liver transplantation at 7 U.S. transplant centers

Author

Berry, Kacey A, Kent, Dorothea, Seetharaman, Srilakshmi, Wong, Randi, Mohamad, Yara, Yao, Frederick, Nunez-Duarte, Maria, Wadhwani, Sharad I, Boyarsky, Brian J, Rahimi, Robert S, Duarte-Rojo, Andres, Kappus, Matthew R, Volk, Michael L, Ladner, Daniela P, Segev, Dorry L, McAdams-DeMarco, Mara, Verna, Elizabeth C, Ganger, Daniel R, and Lai, Jennifer C

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Trials and Supportive Activities, Liver Disease, Organ Transplantation, Aging, Digestive Diseases, Clinical Research, Transplantation, Adult, End Stage Liver Disease, Female, Frailty, Humans, Liver Transplantation, Loneliness, Male, Psychosocial, Social isolation, Quality of life, Cirrhosis, End-stage liver disease, Mental health, Social support, Cardiorespiratory Medicine and Haematology, Gastroenterology & Hepatology, Clinical sciences
Abstract

IntroductionLoneliness, "a subjective feeling of being isolated", is a strong predictor of adverse health. We characterized loneliness in patients with end-stage liver disease (ESLD) awaiting liver transplantation (LT).MethodsWe surveyed loneliness in ambulatory ESLD adults awaiting LT at 7 U.S. sites using the validated UCLA Three-Item Loneliness Scale, May2020-Jan2021; "lonely"=total ≥5. Liver Frailty Index (LFI) assessed frailty; "frail"=LFI≥4.4. Logistic regression associated loneliness and co-variables.ResultsOf 454 participants, median MELDNa was 14 (IQR 10-19) and 26% met criteria for "lonely". Compared to those not lonely, those lonely were younger (57 v. 61y), more likely to be female (48% v. 31%) or frail (21 v. 11%), and less likely to be working (15% v. 26%) or in a committed partnership (52% v. 71%). After multivariable adjustment, frailty (OR=2.24, 95%CI=1.23-4.08), younger age (OR=1.19, 95%CI=1.07-1.34), female sex (OR=1.83, 95%CI=1.14-2.92), not working (OR=2.16, 95%CI=1.16-4.03), and not in a committed partnership (OR=2.07, 95%CI=1.29-3.32) remained significantly associated with higher odds of loneliness.ConclusionLoneliness is prevalent in adults awaiting LT, and independently associated with younger age, female sex and physical frailty. These data lay the foundation to investigate the extent to which loneliness impacts health outcomes in LT, as in the general population. Clinical Trial Registry Website: https://clinicaltrials.gov Trial Number: NCT03228290.

Published
2022

9. National Landscape of Human Immunodeficiency Virus-Positive Deceased Organ Donors in the United States.

Author

Werbel, William A, Brown, Diane M, Kusemiju, Oyinkansola T, Doby, Brianna L, Seaman, Shanti M, Redd, Andrew D, Eby, Yolanda, Fernandez, Reinaldo E, Desai, Niraj M, Miller, Jernelle, Bismut, Gilad A, Kirby, Charles S, Schmidt, Haley A, Clarke, William A, Seisa, Michael, Petropoulos, Christos J, Quinn, Thomas C, Florman, Sander S, Huprikar, Shirish, Rana, Meenakshi M, Friedman-Moraco, Rachel J, Mehta, Aneesh K, Stock, Peter G, Price, Jennifer C, Stosor, Valentina, Mehta, Shikha G, Gilbert, Alexander J, Elias, Nahel, Morris, Michele I, Mehta, Sapna A, Small, Catherine B, Haidar, Ghady, Malinis, Maricar, Husson, Jennifer S, Pereira, Marcus R, Gupta, Gaurav, Hand, Jonathan, Kirchner, Varvara A, Agarwal, Avinash, Aslam, Saima, Blumberg, Emily A, Wolfe, Cameron R, Myer, Kevin, Wood, R Patrick, Neidlinger, Nikole, Strell, Sara, Shuck, Marion, Wilkins, Harry, Wadsworth, Matthew, Motter, Jennifer D, Odim, Jonah, Segev, Dorry L, Durand, Christine M, Tobian, Aaron AR, Piquant, Dominque, Link, Katherine, Hemmersbach-Miller, Marion, Pearson, Thomas, Turgeon, Nicole, Lyon, G Marshall, Kitchens, William, Huckaby, Jeryl, Lasseter, A Francie, Elbein, Rivka, Roberson, April, Ferry, Elizabeth, Klock, Ethan, Cochran, Willa V, Morrison, Michelle, Rasmussen, Sarah, Bollinger, Juli, Sugarman, Jeremy, Smith, Angela R, Thomas, Margaret, Coakley, Margaret, Timpone, Joseph, Stucke, Alyssa, Haydel, Brandy, Dieter, Rebecca, Klein, Elizabeth J, Neumann, Henry, Gallon, Lorenzo, Goudy, Leah, Callegari, Michelle, Marrazzo, Ilise, Jackson, Towanda, Pruett, Timothy, Farnsworth, Mary, Locke, Jayme E, Mompoint-Williams, Darnell, Basinger, Katherine, Mekeel, Kristin, Nguyen, Phirum, Kwan, Joanne, Srisengfa, Tab, Chin-Hong, Peter, Rogers, Rodney, Simkins, Jacques, Munoz, Carlos, and Dunn, Ty

Subjects
Pediatric Research Initiative, HIV/AIDS, Infectious Diseases, 6.1 Pharmaceuticals, Evaluation of treatments and therapeutic interventions, Infection, Good Health and Well Being, Anti-Retroviral Agents, HIV, HIV Infections, HIV Seropositivity, Humans, Integrases, Prospective Studies, Tissue Donors, United States, Viral Load, transplant, organ donation, drug resistance, HOPE in Action Investigators, Biological Sciences, Medical and Health Sciences, Microbiology
Abstract

BackgroundOrgan transplantation from donors with human immunodeficiency virus (HIV) to recipients with HIV (HIV D+/R+) presents risks of donor-derived infections. Understanding clinical, immunologic, and virologic characteristics of HIV-positive donors is critical for safety.MethodsWe performed a prospective study of donors with HIV-positive and HIV false-positive (FP) test results within the HIV Organ Policy Equity (HOPE) Act in Action studies of HIV D+/R+ transplantation (ClinicalTrials.gov NCT02602262, NCT03500315, and NCT03734393). We compared clinical characteristics in HIV-positive versus FP donors. We measured CD4 T cells, HIV viral load (VL), drug resistance mutations (DRMs), coreceptor tropism, and serum antiretroviral therapy (ART) detection, using mass spectrometry in HIV-positive donors.ResultsBetween March 2016 and March 2020, 92 donors (58 HIV positive, 34 FP), representing 98.9% of all US HOPE donors during this period, donated 177 organs (131 kidneys and 46 livers). Each year the number of donors increased. The prevalence of hepatitis B (16% vs 0%), syphilis (16% vs 0%), and cytomegalovirus (CMV; 91% vs 58%) was higher in HIV-positive versus FP donors; the prevalences of hepatitis C viremia were similar (2% vs 6%). Most HIV-positive donors (71%) had a known HIV diagnosis, of whom 90% were prescribed ART and 68% had a VL

Published
2022

11. Pig-to-human heart xenotransplantation in two recently deceased human recipients

Author

Moazami, Nader, Stern, Jeffrey M., Khalil, Karen, Kim, Jacqueline I., Narula, Navneet, Mangiola, Massimo, Weldon, Elaina P., Kagermazova, Larisa, James, Les, Lawson, Nikki, Piper, Greta L., Sommer, Philip M., Reyentovich, Alex, Bamira, Daniel, Saraon, Tajinderpal, Kadosh, Bernard S., DiVita, Michael, Goldberg, Randal I., Hussain, Syed T., Chan, Justin, Ngai, Jennie, Jan, Thomas, Ali, Nicole M., Tatapudi, Vasishta S., Segev, Dorry L., Bisen, Shivani, Jaffe, Ian S., Piegari, Benjamin, Kowalski, Haley, Kokkinaki, Maria, Monahan, Jeffrey, Sorrells, Lori, Burdorf, Lars, Boeke, Jef D., Pass, Harvey, Goparaju, Chandra, Keating, Brendan, Ayares, David, Lorber, Marc, Griesemer, Adam, Mehta, Sapna A., Smith, Deane E., and Montgomery, Robert A.

Published
2023
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15. Wait Time Advantage for Transplant Candidates With HIV Who Accept Kidneys From Donors With HIV Under the HOPE Act

Author

Motter, Jennifer D., Hussain, Sarah, Brown, Diane M., Florman, Sander, Rana, Meenakshi M., Friedman-Moraco, Rachel, Gilbert, Alexander J., Stock, Peter, Mehta, Shikha, Mehta, Sapna A., Stosor, Valentina, Elias, Nahel, Pereira, Marcus R., Haidar, Ghady, Malinis, Maricar, Morris, Michele I., Hand, Jonathan, Aslam, Saima, Schaenman, Joanna M., Baddley, John, Small, Catherine B., Wojciechowski, David, Santos, Carlos A.Q., Blumberg, Emily A., Odim, Jonah, Apewokin, Senu K., Giorgakis, Emmanouil, Bowring, Mary Grace, Werbel, William A., Desai, Niraj M., Tobian, Aaron A.R., Segev, Dorry L., Massie, Allan B., Durand, Christine M., Kusemiju, Oyinkansola, Barnaba, Brittany, Prizzi, Michelle, Liang, Tao, Barnes, Grace Link, Chahoud, Margaret, Wiles, James, Cochran, Willa, Morrison, Michelle, Storm, Kaitlyn, Apte, Anuj, Paredes, Linda, Kuffar, Bahati, Stearns, Quinten, Brown, Nadine, Chang, Amy, Haydel, Brandy M., Pearson, Thomas, Mehta, Aneesh K., Lyon, G. Marshall, Kitchens, William, Huckaby, Jeryl, Elbein, Rivka, Roberson, April, Ferry, Elizabeth, Coakley, Margaret, Akhran, Aleya, Timpone, Joseph, Stucke, Alyssa, Mompoint-Williams, Darnell, Locke, Jayme E., Weldon, Elaina P., Dieter, Rebecca, Klein, Elizabeth, Goudy, Leah, Callegari, Michelle, Gallon, Lorenzo, Hughes, Kailey, Pakstis, Diana Lynn, Silveira, Fernanda, Tomlin, Ricarda, Smith, Angela, Shah, Mita, Mekeel, Kristin, Nguyen, Phirum, Mills, Jeff, Bunnapradist, Suphamai, Gritsch, H. Albin, Moe, Ardis A., Silva, Rosemary, Marrazzo, Ilise D., Muthukumar, Thangamani, Chang, Amy, Hoz, Ricardo La, Hubbard, Jarrett, Mall, Mark, Santos, Carlos, Dunn, Ty, Sawinski, Deirdre, Najdzinowicz, Maryann, Chen, Jeanne M., Nagy, Jamie, and Brigle, Nathaniel

Published
2024
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17. Frailty and the Risk of Acute Kidney Injury Among Patients With Cirrhosis

Author

Cullaro, Giuseppe, Verna, Elizabeth C, Duarte‐Rojo, Andres, Kappus, Matthew R, Ganger, Daniel R, Rahimi, Robert S, Boyarsky, Brian, Segev, Dorry L, McAdams‐DeMarco, Mara, Ladner, Daniela P, Volk, Michael L, Hsu, Chi‐yuan, and Lai, Jennifer C

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Aging, Clinical Research, Digestive Diseases, Transplantation, Chronic Liver Disease and Cirrhosis, Liver Disease, Kidney Disease, Prevention, Renal and urogenital, Good Health and Well Being, Acute Kidney Injury, Frailty, Humans, Liver Cirrhosis, Prospective Studies, Waiting Lists, Clinical sciences
Abstract

Acute kidney injury (AKI) and frailty are major drivers of outcomes among patients with cirrhosis. What is unknown is the impact of physical frailty on the development of AKI. We included adults with cirrhosis without hepatocellular carcinoma listed for liver transplantation at nine US centers (n = 1,033). Frailty was assessed using the Liver Frailty Index (LFI); "frail" was defined by LFI ≥ 4.2. Chronic kidney disease as a baseline estimated glomerular filtration rate

Published
2022

27. Diabetes-free survival among living kidney donors and non-donors with obesity: A longitudinal cohort study

Author

Killian, A Cozette, Reed, Rhiannon D, McLeod, M Chandler, MacLennan, Paul A, Kumar, Vineeta, Pittman, Sydney E, Maynor, Andrew G, Stanford, Luke A, Baker, Gavin A, Schinstock, Carrie A, Silkensen, John R, Roll, Garrett R, Segev, Dorry L, Orandi, Babak J, Lewis, Cora E, and Locke, Jayme E

Subjects
Epidemiology, Health Sciences, Diabetes, Kidney Disease, Prevention, Aging, Nutrition, Obesity, Clinical Research, Renal and urogenital, Cardiovascular, Metabolic and endocrine, Humans, Young Adult, Kidney Transplantation, Longitudinal Studies, Living Donors, Cohort Studies, Kidney Failure, Chronic, Diabetes Mellitus, General Science & Technology
Abstract

BackgroundApproval of living kidney donors (LKD) with end-stage kidney disease (ESKD) risk factors, such as obesity, has increased. While lifetime ESKD development data are lacking, the study of intermediate outcomes such as diabetes is critical for LKD safety. Donation-attributable diabetes risk among persons with obesity remains unknown. The purpose of this study was to evaluate 10-year diabetes-free survival among LKDs and non-donors with obesity.MethodsThis longitudinal cohort study identified adult, LKDs (1976-2020) from 42 US transplant centers and non-donors from the Coronary Artery Risk Development in Young Adults (1985-1986) and the Atherosclerosis Risk in Communities (1987-1989) studies with body mass index ≥30 kg/m2. LKDs were matched to non-donors on baseline characteristics (age, sex, race, body mass index, systolic and diastolic blood pressure) plus diabetes-specific risk factors (family history of diabetes, impaired fasting glucose, smoking history). Accelerated failure time models were utilized to evaluate 10-year diabetes-free survival.FindingsAmong 3464 participants, 1119 (32%) were LKDs and 2345 (68%) were non-donors. After matching on baseline characteristics plus diabetes-specific risk factors, 4% (7/165) LKDs and 9% (15/165) non-donors developed diabetes (median follow-up time 8.5 (IQR: 5.6-10.0) and 9.1 (IQR: 5.9-10.0) years, respectively). While not significant, LKDs were estimated to live diabetes-free 2 times longer than non-donors (estimate 1.91; 95% CI: 0.79-4.64, p = 0.15).ConclusionsLKDs with obesity trended toward living longer diabetes-free than non-donors with obesity, suggesting within the decade following donation there was no increased diabetes risk among LKDs. Further work is needed to evaluate donation-attributable diabetes risk long-term.

Published
2022

28. Motivations and outcomes of compatible living donor–recipient pairs in paired exchange

Author

Chipman, Valerie, Cooper, Matthew, Thomas, Alvin G, Ronin, Matthew, Lee, Brian, Flechner, Stuart, Leeser, David, Segev, Dorry L, Mandelbrot, Didier A, Lunow‐Luke, Tyler, Syed, Shareef, Hil, Garet, Freise, Chris E, Waterman, Amy D, and Roll, Garrett R

Subjects
Organ Transplantation, Transplantation, Clinical Research, Prevention, Kidney Disease, Renal and urogenital, Donor Selection, Female, Humans, Kidney Transplantation, Living Donors, Motivation, Tissue and Organ Procurement, Transplant Recipients, clinical decision-making, clinical research, practice, donors and donation, paired exchange, health services and outcomes research, kidney transplantation, nephrology, living donor, patient education, clinical research/practice, donors and donation: paired exchange, kidney transplantation/nephrology, kidney transplantation: living donor, Medical and Health Sciences, Surgery
Abstract

Increasing numbers of compatible pairs are choosing to enter paired exchange programs, but motivations, outcomes, and system-level effects of participation are not well described. Using a linkage of the Scientific Registry of Transplant Recipients and National Kidney Registry, we compared outcomes of traditional (originally incompatible) recipients to originally compatible recipients using the Kaplan-Meier method. We identified 154 compatible pairs. Most pairs sought to improve HLA matching. Compared to the original donor, actual donors were younger (39 vs. 50 years, p

Published
2022

29. Cognitive Impairment and Physical Frailty in Patients With Cirrhosis

Author

Berry, Kacey, Duarte‐Rojo, Andres, Grab, Joshua D, Dunn, Michael A, Boyarsky, Brian J, Verna, Elizabeth C, Kappus, Matthew R, Volk, Michael L, McAdams‐DeMarco, Mara, Segev, Dorry L, Ganger, Daniel R, Ladner, Daniela P, Shui, Amy, Tincopa, Monica A, Rahimi, Robert S, Lai, Jennifer C, and Study, from the Multi‐Center Functional Assessment in Liver Transplantation

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Liver Disease, Rehabilitation, Digestive Diseases, Chronic Liver Disease and Cirrhosis, Prevention, Clinical Research, Aging, Good Health and Well Being, Aged, Cognitive Dysfunction, Female, Frailty, Humans, Liver Cirrhosis, Liver Transplantation, Male, Middle Aged, Prospective Studies, Waiting Lists, from the Multi-Center Functional Assessment in Liver Transplantation (FrAILT) Study, Clinical sciences
Abstract

Physical frailty and impaired cognition are common in patients with cirrhosis. Physical frailty can be assessed using performance-based tests, but the extent to which impaired cognition may impact performance is not well characterized. We assessed the relationship between impaired cognition and physical frailty in patients with cirrhosis. We enrolled 1,623 ambulatory adult patients with cirrhosis waiting for liver transplantation at 10 sites. Frailty was assessed with the liver frailty index (LFI; "frail," LFI ≥ 4.4). Cognition was assessed at the same visit with the number connection test (NCT); continuous "impaired cognition" was examined in primary analysis, with longer NCT (more seconds) indicating worse impaired cognition. For descriptive statistics, "impaired cognition" was NCT ≥ 45 seconds. Linear regression associated frailty and impaired cognition; competing risk regression estimated subhazard ratios (sHRs) of wait-list mortality (i.e., death/delisting for sickness). Median NCT was 41 seconds, and 42% had impaired cognition. Median LFI (4.2 vs. 3.8) and rates of frailty (38% vs. 20%) differed between those with and without impaired cognition. In adjusted analysis, every 10-second NCT increase associated with a 0.08-LFI increase (95% confidence interval [CI], 0.07-0.10). In univariable analysis, both frailty (sHR, 1.63; 95% CI, 1.43-1.87) and impaired cognition (sHR, 1.07; 95% CI, 1.04-1.10) associated with wait-list mortality. After adjustment, frailty but not impaired cognition remained significantly associated with wait-list mortality (sHR, 1.55; 95% CI, 1.33-1.79). Impaired cognition mediated 7.4% (95% CI, 2.0%-16.4%) of the total effect of frailty on 1-year wait-list mortality. Conclusion: Patients with cirrhosis with higher impaired cognition displayed higher rates of physical frailty, yet frailty independently associated with wait-list mortality while impaired cognition did not. Our data provide evidence for using the LFI to understand mortality risk in patients with cirrhosis, even when concurrent impaired cognition varies.

Published
2022

30. The unfinished journey toward transplant equity: an analysis of racial/ethnic disparities for children after the implementation of the Kidney Allocation System in 2014

Author

Charnaya, Olga, Zeiser, Laura, Yisar, Dolev, Goldberg, Aviva, Segev, Dorry L., Massie, Allan, and Garonzik-Wang, Jacqueline

Subjects
Kidneys -- Transplantation, Health care disparities -- Demographic aspects, Health
Abstract

Background Disparities in pediatric kidney transplantation (KT) result in reduced access and worse outcomes for minority children. We assessed the impact of recent systems changes on these disparities. Methods This is a retrospective cohort study of pediatric patients utilizing data from the US Renal Data System (n = 7547) and Scientific Registry of Transplant Recipients (n = 6567 waitlisted and n = 6848 transplanted patients). We compared access to transplantation, time to deceased donor kidney transplant (DDKT), and allograft failure (ACGF) in the 5 years preceding implementation of the Kidney Allocation System (KAS) to the 5 years post-KAS implementation 2010-2014 vs. 2015-2019, respectively. Results Compared to the pre-KAS era, post-KAS candidates were more likely to be pre-emptively listed (26.8% vs. 38.1%, p < 0.001), pre-emptively transplanted (23.8% vs. 28.0%, p < 0.001), and less likely to have private insurance (35.6% vs. 32.3%, p = 0.01), but these were not uniform across racial groups. Compared to white children, Black and Hispanic children had a lower likelihood of transplant listing within 2 years of first dialysis service (aHR .sub.0.590.67.sub.0.76 and .sub.0.730.82.sub.0.92, respectively) in the post-KAS era. Time to DDKT was comparable across all racial groups in the post-KAS era. Compared to white children, Black DDKT recipients have more 5-year ACGF (aHR .sub.1.001.43.sub.2.06p = 0.05) while there was no difference in 3- or 5-year ACGF among LDKT recipients. Conclusions After KAS implementation, there is equity in time to DDKT. Pre-KAS increased hazard of ACGF among Black children has decreased in the post-KAS era; however, persistent disparities exist in time to transplant listing among Black and Hispanic children when compared to white children. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information, Author(s): Olga Charnaya [sup.1] , Laura Zeiser [sup.2] , Dolev Yisar [sup.3] , Aviva Goldberg [sup.4] , Dorry L. Segev [sup.2] [sup.5] [sup.6] , Allan Massie [sup.2] , Jacqueline Garonzik-Wang [...]

Published
2023
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39. A Metabolomics Approach to Identify Metabolites Associated With Mortality in Patients Receiving Maintenance Hemodialysis

Author

Al Awadhi, Solaf, Myint, Leslie, Guallar, Eliseo, Clish, Clary B., Wulczyn, Kendra E., Kalim, Sahir, Thadhani, Ravi, Segev, Dorry L., McAdams DeMarco, Mara, Moe, Sharon M., Moorthi, Ranjani N., Hostetter, Thomas H., Himmelfarb, Jonathan, Meyer, Timothy W., Powe, Neil R., Tonelli, Marcello, Rhee, Eugene P., and Shafi, Tariq

Published
2024
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41. The relationship between frailty and cirrhosis etiology: From the Functional Assessment in Liver Transplantation (FrAILT) Study

Author

Xu, Chelsea Q, Mohamad, Yara, Kappus, Matthew R, Boyarsky, Brian, Ganger, Daniel R, Volk, Michael L, Rahimi, Robert S, Duarte‐Rojo, Andres, McAdams‐DeMarco, Mara, Segev, Dorry L, Ladner, Daniela P, Verna, Elizabeth C, Grab, Joshua, Tincopa, Monica, Dunn, Michael A, and Lai, Jennifer C

Subjects
Infectious Diseases, Chronic Liver Disease and Cirrhosis, Hepatitis, Liver Disease, Digestive Diseases, Good Health and Well Being, Zero Hunger, Adult, End Stage Liver Disease, Frailty, Humans, Liver Cirrhosis, Liver Transplantation, Waiting Lists, frailty, malnutrition, NAFLD, non-alcoholic fatty liver disease, physical function, sarcopenia, Clinical Sciences, Gastroenterology & Hepatology
Abstract

Background & aimsCirrhosis leads to malnutrition and muscle wasting that manifests as frailty, which may be influenced by cirrhosis aetiology. We aimed to characterize the relationship between frailty and cirrhosis aetiology.MethodsIncluded were adults with cirrhosis listed for liver transplantation (LT) at 10 US centrer who underwent ambulatory testing with the Liver Frailty Index (LFI; 'frail' = LFI ≥ 4.4). We used logistic regression to associate aetiologies and frailty, and competing risk regression (LT as the competing risk) to determine associations with waitlist mortality (death/delisting for sickness).ResultsOf 1,623 patients, rates of frailty differed by aetiology: 22% in chronic hepatitis C, 31% in alcohol-associated liver disease (ALD), 32% in non-alcoholic fatty liver disease (NAFLD), 21% in autoimmune/cholestatic and 31% in 'other' (P  .05 for each). No interaction between frailty and aetiology on the association with waitlist mortality was found (P > .05 for each interaction term).ConclusionsFrailty is more common in patients with ALD, NAFLD and 'other' aetiologies. However, frailty was associated with waitlist mortality independent of cirrhosis aetiology, supporting the applicability of frailty across all cirrhosis aetiologies.

Published
2021

46. Identifying an Optimal Liver Frailty Index Cutoff to Predict Waitlist Mortality in Liver Transplant Candidates

Author

Kardashian, Ani, Ge, Jin, McCulloch, Charles E, Kappus, Matthew R, Dunn, Michael A, Duarte‐Rojo, Andres, Volk, Michael L, Rahimi, Robert S, Verna, Elizabeth C, Ganger, Daniel R, Ladner, Daniela, Dodge, Jennifer L, Boyarsky, Brian, McAdams‐DeMarco, Mara, Segev, Dorry L, and Lai, Jennifer C

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Digestive Diseases, Liver Disease, Organ Transplantation, Transplantation, Good Health and Well Being, End Stage Liver Disease, Female, Frailty, Humans, Liver, Liver Cirrhosis, Liver Transplantation, Male, Middle Aged, Risk Factors, United States, Waiting Lists, Medical Biochemistry and Metabolomics, Immunology, Gastroenterology & Hepatology, Clinical sciences
Abstract

Background and aimsFrailty, as measured by the Liver Frailty Index (LFI), is associated with liver transplant (LT) waitlist mortality. We sought to identify an optimal LFI cutoff that predicts waitlist mortality.Approach and resultsAdults with cirrhosis awaiting LT without hepatocellular carcinoma at nine LT centers in the United States with LFI assessments were included. Multivariable competing risk analysis assessed the relationship between LFI and waitlist mortality. We identified a single LFI cutoff by evaluating the fit of the competing risk models, searching for the cutoff that gave the best model fit (as judged by the pseudo-log-likelihood). We ascertained the area under the curve (AUC) in an analysis of waitlist mortality to find optimal cutoffs at 3, 6, or 12 months. We used the AUC to compare the discriminative ability of LFI+Model for End Stage Liver Disease-sodium (MELDNa) versus MELDNa alone in 3-month waitlist mortality prediction. Of 1,405 patients, 37 (3%), 82 (6%), and 135 (10%) experienced waitlist mortality at 3, 6, and 12 months, respectively. LFI was predictive of waitlist mortality across a broad LFI range: 3.7-5.2. We identified an optimal LFI cutoff of 4.4 (95% confidence interval [CI], 4.0-4.8) for 3-month mortality, 4.2 (95% CI, 4.1-4.4) for 6-month mortality, and 4.2 (95% CI, 4.1-4.4) for 12-month mortality. The AUC for prediction of 3-month mortality for MELDNa was 0.73; the addition of LFI to MELDNa improved the AUC to 0.79.ConclusionsLFI is predictive of waitlist mortality across a wide spectrum of LFI values. The optimal LFI cutoff for waitlist mortality was 4.4 at 3 months and 4.2 at 6 and 12 months. The discriminative performance of LFI+MELDNa was greater than MELDNa alone. Our data suggest that incorporating LFI with MELDNa can more accurately represent waitlist mortality in LT candidates.

Published
2021

50. Living kidney donors with HIV: experience and outcomes from a case series by the HOPE in Action Consortium

Author

Agrawal, Neerja, Pereira, Marcus, Ranganna, Karthik, Wolfe, Cameron, Friedman-Moraco, Rachel, Kitchens, William, Adebiyi, Oluwafisayo, Kubal, Chandrashekhar, Cameron, Andrew, Desai, Niraj, Durand, Christine, Ottmann, Shane, Elias, Nahel, Gilbert, Alexander, Smith, Coleman, Castillo-Lugo, Jose A., Florman, Sander, Segev, Dorry L., Massie, Allan, Mehta, Sapna, Stosor, Valentina, Hand, Jonathan, Blumberg, Emily, Santos, Carlos A.Q., Goldberg, Ryan, Mehta, Shikha, Cannon, Robert, Giorgakis, Emmanouil, Schaenman, Joanna, Aslam, Saima, Stock, Peter, Price, Jennifer, Apewokin, Senu, Benamu, Esther, Spaggiari, Mario, Baddley, John, Morris, Michele I., Simkins, Jacques, Pruett, Timothy, Haidar, Ghady, Wojciechowski, David, Agarwal, Avinash, Balaraman, Vasanthi, Gupta, Gaurav, Chapman, Will, Muthukumar, Thangamani, Small, Catherine B., Malinis, Maricar, Durand, Christine M., Martinez, Nina, Neumann, Karl, Benedict, Reed C., Baker, Arthur W., Wolfe, Cameron R., Shetty, Aneesha, Dietch, Zachary C., Goudy, Leah, Callegari, Michelle A., Massie, Allan B., Brown, Diane, Cochran, Willa, Muzaale, Abimereki, Fine, Derek, Tobian, Aaron A.R., Winkler, Cheryl A., and Al Ammary, Fawaz

Published
2023
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