Association of Karnofsky Performance Status with liver transplant outcomes in hepatocellular carcinoma

Abstract

AbstractBackground Functional performance as measured by the Karnofsky Performance Status (KPS) scale has been linked to the outcomes of liver transplant patients; however, the effect of KPS on the outcomes of the hepatocellular carcinoma (HCC) liver transplant population has not been fully elucidated. We aimed to investigate the association between pre-transplant KPS score and long-term outcomes in HCC patients listed for liver transplantation. Methods Adult HCC candidates listed on the Scientific Registry of Transplant Recipients (SRTR) database from January 1, 2011 to December 31, 2017 were grouped into KPS I (80–100%, n = 8,379), KPS II (50–70%, n = 8,091), and KPS III (10–40%, n = 1,256) based on percentage KPS score at listing. Survival was compared and multivariable analysis was performed to identify independent predictors. Results Patients with low KPS score had a higher risk of removal from the waiting list. The intent-to-treat survival and overall survival were significantly inferior for KPS III patients compared with KPS I and II (P < 0.001). Multivariable analysis demonstrated that KPS was an independent predictor of intent-to-treat survival and overall survival. KPS III patients had an increased cumulative rate of post-transplant tumor recurrence in the univariable analysis (P = 0.037), but this was not significant in the competing regression analysis. Conclusions Low pre-transplant KPS score is associated with inferior long-term survival in liver transplant HCC patients, but is not significantly associated with post-transplant tumor recurrence.