Transplantation proceedings · 2026
Association of Frailty With Waitlist and Post-Transplant Outcomes in Patients With Hepatopulmonary Syndrome and Portopulmonary Hypertension.
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Sharma Arjun, Usman Leena, Lai Jennifer C, Jutras Gabrielle
Аннотация
BACKGROUND: Patients with hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PPHTN) receive MELD exception points due to high mortality risk not captured by laboratory MELD scores. These patients are often excluded from frailty studies, leaving the prognostic significance of functional status unclear. We aimed to determine whether Karnofsky Performance Status (KPS) predicts waitlist and post-transplant outcomes among HPS/PPHTN candidates and to compare outcomes with similarly low-functioning non-exception candidates.
METHODS: We analyzed adult LT candidates in the UNOS/OPTN database (2013-2023) with MELD exception points for HPS/PPHTN and available KPS scores. KPS was categorized as low (10-40), intermediate (50-70), and high (80-100) at listing and nearest to transplant. Outcomes were evaluated using Kaplan-Meier methods, stratified by KPS and compared to non-exception candidates.
RESULTS: Among 1538 HPS/PPHTN patients, 31% had low KPS, 56% intermediate, and 13% high KPS. Within this cohort, low KPS was associated with significantly higher waitlist mortality (p < .001), but post-transplant survival did not differ by KPS (p = .05). Compared to non-exception patients, low KPS HPS/PPHTN candidates had lower waitlist mortality (p < .05), but similar post-transplant survival (p = .26).
CONCLUSION: Compared to those with KPS≥50, HPS/PPHTN candidates with low (≤40) KPS experience higher waitlist mortality, but lower waitlist mortality than non-exception candidates with similar functional impairment. In HPS/PPHTN patients, low KPS may reflect limitations from cardiopulmonary dysfunction rather than systemic frailty or advanced liver disease. These findings highlight the need for frailty assessments tailored to the unique physiology of this subgroup.
METHODS: We analyzed adult LT candidates in the UNOS/OPTN database (2013-2023) with MELD exception points for HPS/PPHTN and available KPS scores. KPS was categorized as low (10-40), intermediate (50-70), and high (80-100) at listing and nearest to transplant. Outcomes were evaluated using Kaplan-Meier methods, stratified by KPS and compared to non-exception candidates.
RESULTS: Among 1538 HPS/PPHTN patients, 31% had low KPS, 56% intermediate, and 13% high KPS. Within this cohort, low KPS was associated with significantly higher waitlist mortality (p < .001), but post-transplant survival did not differ by KPS (p = .05). Compared to non-exception patients, low KPS HPS/PPHTN candidates had lower waitlist mortality (p < .05), but similar post-transplant survival (p = .26).
CONCLUSION: Compared to those with KPS≥50, HPS/PPHTN candidates with low (≤40) KPS experience higher waitlist mortality, but lower waitlist mortality than non-exception candidates with similar functional impairment. In HPS/PPHTN patients, low KPS may reflect limitations from cardiopulmonary dysfunction rather than systemic frailty or advanced liver disease. These findings highlight the need for frailty assessments tailored to the unique physiology of this subgroup.