studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 627A
841
Physical function predicts length of stay (LOS) after liver
transplant (LT): From the Functional Assessment in Liver
Transplantation (FrAILT) Study
Jennifer C. Lai, Kenneth E. Covinsky, Iryna Lobach, Sandy Feng;
UCSF, San Francisco, CA
Background: Cirrhosis causes sarcopenia and undernutrition
resulting in progressive decline in physical function(fxn). The
impact of physical fxn on outcomes after LT is unknown. Methods:
Adult LT recipients with ≥90 days(d) post-LT follow up
underwent outpatient pre-LT tests of physical fxn: gait speed+balance+chair
stands=composite Short Physical Performance
Battery (SPPB; range 12=high fxn to 0=low fxn). Cut-offs of
SPPB≤9(low fxn) and lab LT-MELD≥30 were selected for clinical
relevance. The 1° outcome was LT length of stay (LOS);
the 2° outcome was home discharge (vs. acute care or skilled
nursing facility). Adjusted negative binomial regression evaluated
LOS with physical fxn; Weibull time-to-event analyses
associated physical fxn with time to discharge home. Results:
Included were 171 LT recipients: median age 60y. Median
[interquartile range(IQR)] lab MELD at testing was 16(13-21)
and time from physical fxn testing to LT 1.9mos (1.0-3.8). Low
physical fxn (SPPB≤9) was observed in 36%. Median(IQR) lab
MELD at LT was 22 (17-31); 30% had lab LT-MELD≥30. Median(IQR)
LOS for SPPB≤9 and >9 were 9(7-20) and 8(6-14)
[p9 (81vs.89%; p=0.18). In time-to-event analyses adjusted for
MELD and age, SPPB≤9 was associated with 38% decreased
hazard of home discharge (95%CI=9-58%; p=0.02). Conclusions:
Pre-LT physical fxn is a critical determinant of post-LT LOS
and discharge home. Our data support the implementation
of objective measures of physical fxn into clinical practice to
identify those who may benefit from pre- and post-LT physical
activity interventions.
842
Low serum testosterone predicts outcome in men with
cirrhosis independent of the MELD score
Marie Sinclair 1,2 , Adam Shannon 2 , Mathis Grossmann 2 , Peter W.
Angus 1,2 , Rudolf Hoermann 2 , Paul Gow 1,2 ; 1 Gastroenterology,
Austin Hospital, Heidelberg, VIC, Australia; 2 Medicine, The University
of Melbourne, Melbourne, VIC, Australia
Background: Low serum testosterone has been independently
associated with mortality in a retrospective study of men
with advanced liver disease. This study aims to prospectively
explore the relationship between low testosterone and outcome
in a large cohort of men with cirrhosis Methods: We conducted
a prospective observational study at a single centre. All men
with cirrhosis were invited to undergo baseline sex hormone
profile screening during outpatient consultations. Standard
parameters including MELD score and Child Pugh Score were
also documented at baseline. Patients were then followed for
12 months to assess the composite end-point of mortality or
liver transplantation. Secondary outcomes include mortality,
transplantation, hospitalisation and fracture. Results: 203 men
with cirrhosis were enrolled between April 2013 and March
2014. The median age was 55 years [50, 64], Child Pugh
score was 6 [5, 9] MELD score was 10 [8, 15]. The median
total testosterone level was 17.6nmol/L [8.55, 25.35] (normal
10-27.6nmol/L) and 28.1% of men had low total testosterone.
During the 12 month follow-up period 27 patients died and 12
patients received a liver transplant. Median serum testosterone
was lower in men who died than those who did not (3.20nmol/L
[1.05; 12.6] versus 18.1nmol/L [10.6; 26.0], p