Disability in patients with end-stage liver disease: Results from the functional assessment in liver transplantation study.

Cirrhosis leads to sarcopenia and functional decline that can severely impact one's ability to function at home and in society. Self-reported disability scales to quantify disability-Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL)-are validated to predict mortality in older adults. To evaluate disability in liver transplantation (LT) candidates and quantify its impact on outcomes, consecutive outpatients ≥18 years listed for LT with laboratory Model for End-Stage Liver Disease scores of ≥12 at a single high-volume US LT center were assessed for ADLs and IADLs during clinic visits. Multivariate competing risk models explored the effect of disabilities on wait-list mortality (death or delisting for illness). Of 458 patients, 36% were women, median (interquartile range [IQR]) age was 60 years (IQR, 54-64 years), and initial Model for End-Stage Liver Disease-Sodium (MELD-Na) was 17 (IQR 14-20). At first visit, 31% had lost ≥ 1 ADL, and 40% had lost ≥ 1 IADL. The most prevalent ADL deficits lost were continence (22%), dressing (12%), and transferring (11%); the most prevalent IADLs lost were shopping (28%), food preparation (23%), and medication management (22%). After adjustment for age, MELD-Na, and encephalopathy, dressing (subdistribution hazard ratio [SHR], 1.7; 95% confidence interval [CI], 1.0-2.8; P = 0.04), toileting (SHR, 1.9; 95% CI, 1.1-3.5; P = 0.03), transferring (SHR, 1.9; 95% CI, 1.1-3.0; P = 0.009), housekeeping (SHR, 1.8; 95% CI, 1.2-3.0; P = 0.009), and laundry (SHR, 2.2; 95% CI, 1.3-3.5; P = 0.002) remained independent predictors of wait-list mortality. In conclusion, ADL/IADL deficits are common in LT candidates. LT candidates would benefit from chronic disease management programs developed to address the impact of cirrhosis on their daily lives. Liver Transplantation 23 292-298 2017 AASLD.

Factors Associated with Medication Non-adherence in Patients with End-Stage Liver Disease.

BACKGROUND: Low medication adherence is known to contribute to worse health outcomes in the general population. AIM: We aimed to evaluate the medication regimen and determine the adherence levels among patients with end-stage liver disease. METHODS: We measured adherence in patients awaiting liver transplantation at a single center using the 8-item Morisky Medication Adherence Scale (MMAS-8), with a score <8 classified as low adherence. Medication regimen complexity was assessed using the Medication Regimen Complexity Index (MRCI) tool. Factors associated with low adherence were identified by logistic regression. RESULTS: Of 181 patients, 33% were female, median age was 62, and model for end-stage liver disease (MELD) score was 13. The median (IQR) number of medications was 10 (7-13), and the MRCI was 19 (13-27). In total, 54 (30%) were high adherers, and 127 (70%) were low adherers. In total, 42% reported sometimes forgetting to take their medication and 22% reported intermittent adherence within the past 2 weeks. The most common reasons for low adherence were: forgetfulness (27%) and side effects (14%). Compared to high adherence, low adherence was associated with higher number of medications, medication complexity, and diabetes, but lower rates of hepatocellular carcinoma and self-perceived health. In univariable logistic regression, total medication number (OR 1.08), MRCI (OR 1.04), diabetes (OR 2.38), HCC (OR 0.38), and lower self-perceived health (OR 1.37), were statistically significant factors associated with non-adherence. In multivariate analysis, only medication number without supplements (OR 1.14) remained significantly associated with medication non-adherence. CONCLUSION: A majority of patients awaiting liver transplantation demonstrated low medication adherence. Total number of medications and regimen complexity were strong correlates of low adherence. Our data underscores the need for chronic liver disease management programs to improve medication adherence in this vulnerable population.