Evaluation for liver transplantation (LT) focuses on organ-specific testing intended to determine a candidate’s fitness for transplantation. However, simple tests of global physical function may provide complementary information. Six minute walk distance (6MWD) predicts mortality on the wait list and sarcopenia predicts mortality both before and after LT.

Aim: To investigate the strength of association between markers of global physical function (6MWD, sarcopenia) with more focused organ-specific testing: cardiac ejection fraction (EF) both during rest and stress, left atrial volume index (LAVI), and respiratory function (forced expiratory volume in 1 second (FEVI) maximum voluntary ventilation (MVV) in ESLD patients awaiting LT

Methods:

All study patients underwent 6MWD, spirometry and dobutamine echocardiogram prior to LT. Sarcopenia was assessed by measuring the left and right psoas areas (total psoas area, TPA) at the level of fourth lumbar vertebrae on a cross-sectional computed tomography or magnetic resonance imaging performed as a part of pre-transplant evaluation. Clinical and demographics data were collected for all patients. Means and standard deviations were calculated for the variables of interest. Correlation coefficients were calculated for 6MWT data with the spirometric and cardiac parameters and TPA.

Results:

In 217 ESLD patients awaiting LT, the mean age was 54.5 ±9 and 137 (63.1%) were males. HCV (44.7%) was the most common indication for LT. Mean MELD score was 14.6. The mean 6MWD was 395.9±118.6m and TPA was 1272.4 mm². Among the cardiac parameters, the mean EF and LAV1 was 69.2 and 35 mL/m² respectively. 6MWD did not correlate with EF (both rest and at stress) or FEV1. However, 6MWD showed weak inverse correlation with LAVI (r=-0.30, p=0.0004) and positive correlation with MVV(r=0.33, p>0.0001). There was no significant association between 6MWD and TPA (r=0.04, p=0.5).

Conclusions:

Standard cardiopulmonary parameters such as EF and FEV1 did not correlate with the 6MWD in patients with ESLD. However, LAVI which reflects changes in left ventricular diastolic function, showed weak association with 6MWD. 6MWD evaluates the global and integrated responses of all systems involved in exercise and is independent of sarcopenia. 6MWD should be integrated as a useful tool to assess functional status for ESLD patients on the wait list.

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