End-Stage Liver Disease Comorbidities in Patients Awaiting Transplantation: Identification and Impact on Liver Transplant Survival

TL;DR

This study identifies common comorbidities in ESLD patients awaiting liver transplant, analyzes their progression, and evaluates their impact on post-transplant survival, highlighting key predictors such as age, diabetes, and kidney disease.

Contribution

It provides a comprehensive analysis of comorbidity trajectories in ESLD patients and their influence on transplant outcomes, filling a gap in evidence-based guidelines.

Findings

Diabetes Mellitus and Chronic Kidney Disease are the most frequent comorbidities.

Post-transplant survival declines gradually, with significant drops at five years.

Age, waitlist time, DM, low albumin, and CKD stage 5 are significant survival predictors.

Abstract

End-Stage Liver Disease (ESLD), a complex condition, has high rates of co-occurring comorbidities affecting multiple organ systems. There is no clear evidence-based practice (EBP) guidelines addressing the progression of comorbidities in ESLD patients awaiting liver transplantation (LT) and their impact on survival, both pre- and post-transplant. This study aimed to identify and quantify the trajectory of the most common and deteriorating comorbidities in ESLD patients awaiting LT and to analyze their effect on patient outcomes. An initial exploratory phase to identify frequent comorbidities in ESLD patients. Relevant EBP-driven data for diagnosing and measuring the progression of these conditions were collected and organized into five research matrices. In the quantitative phase, a retrospective analysis was conducted using longitudinal de-identified data from electronic health records (EHR) for patients who underwent LT between 2011-2021. Data included demographics, labs, procedures, and medications. Descriptive statistics and survival analysis assessed the association of comorbidities with post-transplant survival. The five most frequent comorbidities identified were Diabetes Mellitus (DM), Chronic Kidney Disease (CKD), Malnutrition, Portal Hypertension (PH), and Ascites. Of the 722 patients analyzed, 68.2% were male, mean age of 54.81 (SD = 11.24), and 19.8% died post-LT. Survival analysis showed a gradual decline over time, with the most significant drop at five years post-LT. Significant predictors of post-LT survival were age at transplant (p=0.01), waitlist time (p=0.004), DM at listing (p=0.02), low albumin (p=0.03), and CKD stage 5 development after listing (p=0.04). This study highlights the variability in diagnosing and measuring comorbidities in ESLD patients and provides insights into their progression and impact on post-LT survival.