Association of Karnofsky Performance Status with waitlist mortality among older and younger adults awaiting kidney transplantation. Issue 6 (3rd April 2020)

• Record Type: Journal Article
• Authors: Sheshadri, Anoop; Cullaro, Giuseppe; Johansen, Kirsten L.; Lai, Jennifer C.
• Is Part Of: Clinical transplantation. Volume 34:Issue 6(2020)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2020-04-03
• Subjects: age -- delisting -- end‐stage renal disease -- Karnofsky Performance Status -- waitlist; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ctr.13848
• Languages: English
• ISSNs: 0902-0063

Abstract

Abstract: Patients with end‐stage renal disease (ESRD) have impaired functional status compared with the general population. We sought to explore the association between Karnofsky Performance Status (KPS) and death/delisting from the kidney transplantation waitlist and whether this association differed by age. Patients listed for single‐organ kidney transplantation in the United Network for Organ Sharing/Organ Procurement and Transplantation Network from January 1, 2015, to January 1, 2018, were included. We performed competing‐risk regression analyses to determine the association between KPS ("Severely impaired", "Moderately impaired", "Non‐impaired") and death/delisting, with deceased‐donor kidney transplantation as a competing risk. We tested for interactions between age and KPS on death/delisting. Of the 89, 819 patients analyzed, 39% were impaired (KPS < 80) and 20% were aged ≥ 65 years. Older age and lower KPS were independently associated with higher risk of death/delisting (age 45‐64 years, HR 1.97 [95% CI 1.73‐2.24]; age ≥ 65 years, HR 3.62 [95% CI 3.33‐3.92] compared with age < 45 years; moderately impaired, HR 1.68 [95% CI 1.45‐1.95]; severely impaired, HR 4.80 [95% CI 3.71‐6.21] compared with non‐impaired). Lower KPS was associated with higher risk of death/delisting among all ages, but this effect was slightly less pronounced among individuals aged ≥ 65 years. Performance status should be used when counseling patients with ESRD on their risks for death/delisting.