6 Minute Walk Distance and Physical Component Score, but Not Sarcopenia, Are Associated with Pre-Transplant Mortality in Patients with End Stage Liver Disease

A. Yadav, Carpenter, Chang, Silva, Aqel, Byrne, Douglas, Vargas, Carey

Hepatology, Mayo Clinic, pheonix
Radiology, Mayo Clinic, Pheonix
Biostatistics, Mayo Clinic, Pheonix

Meeting: 2013 American Transplant Congress

Abstract number: 540

Sarcopenia (loss of muscle mass) is commonly seen in patients with end stage liver disease (ESLD). Reduction in health related quality of life and decline in functional capacity is also noted in ESLD patients awaiting liver transplantation (LT). Six minute walk distance (6MWD) and short form 36 (SF-36) can be used to assess functional exercise capacity and quality of life. Both sarcopenia and 6MWD have been shown to predict mortality in LT candidates. However, there are no studies comparing 6MWD, SF- 36 scores, sarcopenia and other clinical parameters between surviving patients and candidates who died while awaiting LT.

Aim:

To compare the 6MWD, muscle mass, SF-36 scores and other parameters between patients transplanted or still awaiting LT vs. patients who died on the waiting list.

Methods:

276 patients listed for LT were divided into 2 groups. Group 1(n=217) included all patients who remained on the wait list or underwent LT. Group 2 (n=59) patients who died on the wait list. Data collected: age, gender, etiology of liver disease, albumin, bilirubin, INR, Model for End-Stage Liver Disease (MELD) score, 6MWD, SF-36 scores (physical component score (PSC) and mental component score (MCS). Sarcopenia was assessed by the total psoas area (TPA) on pre-LT cross-sectional imaging (either computerized tomography or magnetic resonance imaging)

Results:

Demographics, clinical characteristics and results are shown in Table 1.

Table1: clinical characteristics of both groups
Variable	Group 1	Group 2	p value
Age	54.3	57.7	0.003
Males	136	36	0.816
MELD	14.1	19.4	<0.0001
Albumin, g/dl	3.5	3	<0.0001
Bilirubin, mg/dl	3.9	6.2	0.088
INR	1.4	1.7	0.012
6MWD, m	401	298	<0.0001
PCS, points	34.7	30.5	0.02
MCS, points	47.5	44.1	0.08
TPA, mm(2)	1279.3	949.9	0.08

HCV (45%) is the most common etiology of liver disease. Mean TPA area was 1206 mm² and mean density was 27. hounsfield units.

Group 2 patients had higher MELD score, lower 6MWD and PCs compared to group 1

Conclusions

Measures of physical function are reduced in patients awaiting LT and are associated with increased risk of death on the wait list. Routine measurement of physical function may help to identify patients at increased risk, and allow for targeted interventions. Larger studies are needed to elucidate the prognostic value of 6MWD combined with SF-36 and sarcopenia in ESLD patients.

To cite this abstract in AMA style:

Yadav A. 6 Minute Walk Distance and Physical Component Score, but Not Sarcopenia, Are Associated with Pre-Transplant Mortality in Patients with End Stage Liver Disease [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/6-minute-walk-distance-and-physical-component-score-but-not-sarcopenia-are-associated-with-pre-transplant-mortality-in-patients-with-end-stage-liver-disease/. Accessed November 29, 2024.

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