GSBS Dissertations and Theses
Publication Date
2016-04-04
Document Type
Doctoral Dissertation
Academic Program
Clinical and Population Health Research
Department
Surgery
First Thesis Advisor
Adel Bozorgzadeh, MD, FACS
Second Thesis Advisor
Fred A. Anderson, PhD
Keywords
Health Status, Liver Transplantation, Quality Improvement, Transplant Recipients, Sarcopenia, Survival Analysis, Patient Outcome Assessment, Waiting Lists
Subjects
Dissertations, UMMS; Health Status; Liver Transplantation; Quality Improvement; Transplant Recipients; Sarcopenia; Survival Analysis; Patient Outcome Assessment; Waiting Lists
Abstract
In recent years, the transplant community has explored and adopted tools for quantifying clinical insight into illness severity and frailty. This dissertation work explores the interplay between objective and subjective assessments of physical health status and the implications for liver transplant candidate and recipient outcomes. The first aim characterizes national epidemiologic trends and the impact of Centers for Medicare and Medicaid quality improvement policies on likelihood of waitlist removal based on the patient being too frail to benefit from liver transplant (“too sick to transplant”). This aim includes more than a decade (2002–2012) of comprehensive national transplant waitlist data (Scientific Registry of Transplant Recipients (SRTR)). The second aim will assess and define objective parameters of liver transplant patient frailty by measuring decline in lean core muscle mass (“sarcopenia”) using abdominal CT scans collected retrospectively at a single U.S. transplant center between 2006 and 2015. The relationship between these objective sarcopenia measures and subjective functional status assessed using the Karnofsky Functional Performance (KPS) scale are described and quantified. The third aim quantifies the extent to which poor functional status (KPS) pre-transplant is associated with worse post-transplant survival and includes national data on liver transplantations conducted between 2005 and 2014 (SRTR). The results of this dissertation will help providers in the assessment of frailty and subsequent risk of adverse outcomes and has implications for strategic clinical management in anticipation of surgery. This research will also to serve to inform national policy on the design of transplant center performance measures.
Repository Citation
Dolgin, NH. Frailty and Outcomes in Liver Transplantation: A Dissertation. (2016). University of Massachusetts Medical School. GSBS Dissertations and Theses. Paper 817. DOI: 10.13028/M2759F. https://escholarship.umassmed.edu/gsbs_diss/817
DOI
10.13028/M2759F
DOI Link
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Copyright is held by the author, with all rights reserved.
Included in
Clinical Epidemiology Commons, Epidemiology Commons, Health Services Administration Commons, Surgery Commons