Boateng S, Ameyaw P, Gyabaah S, Adjepong Y, Njei B. Recipient functional status impacts on short and long-term intestinal transplant outcomes in United States adults. World J Transplant 2024; 14(3): 93561 [PMID: 39295973 DOI: 10.5500/wjt.v14.i3.93561]
Corresponding Author of This Article
Sarpong Boateng, MD, Doctor, Department of Medicine, Yale New Haven Health, Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610, United States. sarpong1500@gmail.com
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Sep 18, 2024; 14(3): 93561 Published online Sep 18, 2024. doi: 10.5500/wjt.v14.i3.93561
Recipient functional status impacts on short and long-term intestinal transplant outcomes in United States adults
Sarpong Boateng, Prince Ameyaw, Solomon Gyabaah, Yaw Adjepong, Basile Njei
Sarpong Boateng, Prince Ameyaw, Department of Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT 06610, United States
Sarpong Boateng, Department of Epidemiology and Biostatistics, University of North Texas, Fort Worth, TX 76107, United States
Solomon Gyabaah, Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi KS 1934, Ghana
Yaw Adjepong, Yale University School of Medicine, New Haven, CT 06520, United States
Basile Njei, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT 06520, United States
Author contributions: Boateng S designed the research study; Boateng S, Adjepong Y and Njei B analyzed the data; Boateng S, Ameyaw P, Gyabaah S, Adjepong Y and Njei B wrote the manuscript. All authors have read and approved the final manuscript.
Institutional review board statement: Study contained deidentified patient information and was thus deemed IRB exempt by the Yale New Haven Health Institutional review board.
Informed consent statement: Consent was not obtained but the presented data are anonymized and risk of identification is low.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest, financial or otherwise, to disclose in relation to this study. There are no funding sources for the manuscript.
Data sharing statement: All datasets were extracted and analyzed from the UNOS Program. The data is publicly available online at https://unos.org/
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sarpong Boateng, MD, Doctor, Department of Medicine, Yale New Haven Health, Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610, United States. sarpong1500@gmail.com
Received: February 29, 2024 Revised: May 27, 2024 Accepted: June 13, 2024 Published online: September 18, 2024 Processing time: 152 Days and 14.5 Hours
Abstract
BACKGROUND
Recipient functional status prior to transplantation has been found to impact post-transplant outcomes in heart, liver and kidney transplants. However, information on how functional status, before and after transplant impacts post-transplant survival outcomes is lacking.
AIM
To investigate the impact of recipient functional status on short and long term intestinal transplant outcomes in United States adults.
METHODS
We conducted a retrospective cohort study on 1254 adults who underwent first-time intestinal transplantation from 2005 to 2022. The primary outcome was mortality. Using the Karnofsky Performance Status, functional impairment was categorized as severe, moderate and normal. Analyses were conducted using Kaplan-Meier curves and multivariable Cox regression.
RESULTS
The median age was 41 years, majority (53.4%) were women. Severe impairment was present in 28.3% of recipients. The median survival time was 906.6 days. The median survival time was 1331 and 560 days for patients with normal and severe functional impairment respectively. Recipients with severe impairment had a 56% higher risk of mortality at one year [Hazard ratio (HR) = 1.56; 95%CI: 1.23–1.98; P < 0.001] and 58% at five years (HR = 1.58; 95%CI: 1.24–2.00; P < 0.001) compared to patients with no functional impairment. Recipients with worse functional status after transplant also had poor survival outcomes.
CONCLUSION
Pre- and post-transplant recipient functional status is an important prognostic indicator for short- and long-term intestinal transplant outcomes.
Core Tip: Pre- and post-transplant assessment of recipient functional status using the Karnofsky Performance Status scale is crucial for predicting short- and long-term outcomes in intestinal transplantation. Severe impairment significantly increases the risk of mortality at one- and five-years post-transplant, emphasizing the importance of comprehensive pre-transplant evaluation and potential interventions to optimize functional status in recipients undergoing intestinal transplantation in the United States.
