Disability in Patients With End- Stage Liver Disease: Results From the Functional Assessment in Liver Transplantation Study

Cirrhosis leads to sarcopenia and functional decline that can severely impact one's ability to function at home and in society. Self-reported disability scales to quantify disabilityActivities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL)are validated to predict mortality in older adults. To evaluate disability in liver transplantation (LT) candidates and quantify its impact on outcomes, consecutive outpatients 18 years listed for LT with laboratory Model for End-Stage Liver Disease scores of 12 at a single high-volume US LT center were assessed for ADLs and IADLs during clinic visits. Multivariate competing risk models explored the effect of disabilities on wait-list mortality (death or delisting for illness). Of 458 patients, 36% were women, median (interquartile range [IQR]) age was 60 years (IQR, 54-64 years), and initial Model for End-Stage Liver Disease-Sodium (MELD-Na) was 17 (IQR 14-20). At first visit, 31% had lost1 ADL, and 40% had lost1 IADL. The most prevalent ADL deficits lost were continence (22%), dressing (12%), and transferring (11%); the most prevalent IADLs lost were shopping (28%), food preparation (23%), and medication management (22%). After adjustment for age, MELD-Na, and encephalopathy, dressing (subdistribution hazard ratio [SHR], 1.7; 95% confidence interval [CI], 1.0-2.8; P=0.04), toileting (SHR, 1.9; 95% CI, 1.1-3.5; P=0.03), transferring (SHR, 1.9; 95% CI, 1.1-3.0; P=0.009), housekeeping (SHR, 1.8; 95% CI, 1.2-3.0; P=0.009), and laundry (SHR, 2.2; 95% CI, 1.3-3.5; P=0.002) remained independent predictors of wait-list mortality. In conclusion, ADL/IADL deficits are common in LT candidates. LT candidates would benefit from chronic disease management programs developed to address the impact of cirrhosis on their daily lives.