studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 825A
Geoff McCaughan - Advisory Committees or Review Panels: Gilead
The following authors have nothing to disclose: Astrid-Jane Greenup, Gokulan
Pavendranathan, Mathew J. Keegan, Sean Griffin, David Bowen, Warwick
Selby, Nicholas A. Shackel, David J. Koorey
1244
The Gap Between Assessed Physical Capacity And
Actual Activity In Advanced Cirrhosis
Michael A. Dunn 1,2 , Deborah A. Josbeno 3 , Amy R. Schmotzer 1 ,
Doug Landsittel 1,2 , Anthony Delitto 3 ; 1 Medicine, University of Pittsburgh,
Pittsburgh, PA; 2 Thomas E Starzl Transplantation Institute,
University of Pittsburgh, Pittsburgh, PA; 3 Physical Therapy, University
of Pittsburgh, Pittsburgh, PA
Background: Muscle wasting in cirrhosis is a major cause of
deterioration, transplant waitlist removals and deaths. It is
associated with deconditioning and impaired physical performance,
and becomes apparent as anatomic sarcopenia on
imaging. Physical inactivity is a known driver of muscle wasting
in chronic diseases. We instruct waitlisted patients to maintain
regular activity and mandate the assessment of physical performance
capacity for listing. However, very little is known about
whether such assessments predict or reflect the extent of physical
activity that patients actually perform to sustain health while
awaiting transplantation. Methods: We asked 43 waitlisted
patients to self-assess their ability to perform ordinary physical
tasks using the Rosow-Breslau survey. We also recorded their
Karnofsky physical capacity assessments from UNOS listing
records. We then measured actual physical activity using a
wearable armband with accelerometer and thermal sensing to
record (a) percentage of waking time spent in sedentary (0-1.5
METs), light (1.5-3.0 METS) and moderate-to-vigorous (>3.0
METS) activity, (b) daily steps, and (c) daily energy expenditure
in kcal. Results: We were able to acquire analyzable
data for a 4 to 7 day wear period in 30 of the 43 patients
(21 men, 9 women; age 57.5 ± 8.9; MELD 17.2 ± 6.2). Their
measured levels of physical activity were among the lowest
reported in chronic disease, comparable with that of COPD
patients using oxygen or chronic renal failure patients on dialysis.
Their percentages of waking hours spent in sedentary,
light, and moderate-to-vigorous activity were 80.8 ± 14.7%,
16.6 ± 13.0%, and 2.5 ± 2.7%, respectively. Compared with
a range of 7,000-13,000 steps/day in healthy adults, their
mean steps/day were 3132 ± 2022, range 552-8414. Both
the activity percentage and step data were typical of other
severely inactive populations. Mean daily energy expenditure
was 2287 ± 468 kcal, as expected for their age range. Neither
the self-assessed Rosow-Breslau scores (mean 2.5 ± 0.8,
maximum 3.0) nor the provider-generated Karnofsky scores
(mean 79.7 ± 11.3, maximum 100) indicated major impairment
or showed a significant correlation with patients’ actual
performance measured either by activity percentage or daily
steps. Conclusion: Physical activity in cirrhotic patients is highly
sedentary. Self and provider assessments of capacity do not
correlate with actual performance. The extent to which a potential
gap between assessed capacity and performance may be
favorably modified by motivational, exercise, and nutritional
interventions to improve activity and ameliorate muscle wasting
is unclear, and merits further study.
Disclosures:
The following authors have nothing to disclose: Michael A. Dunn, Deborah A.
Josbeno, Amy R. Schmotzer, Doug Landsittel, Anthony Delitto
1245
Liver Transplantation in Older Recipients
Denise M. Harnois, Kaitlyn R. Musto, Bhupendra Rawal, Justin H.
Nguyen; Mayo Clinic, Jacksonville, FL
Introduction: The role of liver transplantation (LT) in elderly
recipients (≥70 years) is controversial. Over the last decade,
longevity has improved so that individuals who reach 70 years
of age can expect an additional 15 years of life (http://cdc.
gov/NCHS/products/nvsr.htm#vol58/). To address this issue,
we review our experience of LT at a single large volume center
to determine if LT is a reasonable option for older recipients to
reclaim their expected lifespan if liver failure can be overcome.
Methods: Retrospective analysis of 2524 LT recipients from
1998 to 2013 was completed. Recipients of primary, whole,
non-DCD, liver alone transplants, non-CCCA, and recipient
age ≥18 were included. Clinically available variables including
patient and graft survival along with donor and recipient
characteristics were used. Results: Median recipient age was
56 years (Range: 18-80) with a total of 1853 patients that
included 129 older (≥70 years), 1482 middle-aged (46-69
years), and 242 young (18-45 years) LT recipients. 1221 (66%)
recipients were male. Median raw MELD was 16 (Range: 6-51)
with median of 15 (Range: 6-43) for elderly. 40% had history
of HCV and 22% with HCC. Post-LT median LOS was 7 days
(Range: 0-446) and 8 days (Range: 0-105) for older recipients.
933 (50.4%) of all recipients were sent to ICU post-LT, 65
(50.4%) of older patients. Overall patient survival post-LT was
95%. The 5-year patient survival was 85.1% (graft 73.5%) in
young, 79.4% (graft 74.8%) in middle-aged, and 72.7% (graft
69.0%) in older recipients. The 10-year survival was 72.1%
(graft 59.5%) in young, 69.1% (graft 65.1%) in middle-aged,
and 51.2% (graft 48.5%) in older recipients. Conclusion: LT
offers the elderly a chance to reclaim their expected lifespan as
they regain their liver function. Moreover, mortality, graft loss,
LOS and requirement for ICU in older recipients are similar to
those of young recipients. Therefore, LT in older recipient can
be successful and should be considered in selected patients.
Disclosures:
The following authors have nothing to disclose: Denise M. Harnois, Kaitlyn R.
Musto, Bhupendra Rawal, Justin H. Nguyen