Association of physiological reserve measures with adverse outcomes following liver transplantation

James S. Kimber, Richard J. Woodman, Sumudu K. Narayana, Libby John, Jeyamani Ramachandran, David Schembri, John W.C. Chen, Kate R. Muller, Alan J. Wigg

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Background and Aim: The comparative utility of physiological reserve measures in predicting important clinical outcomes following liver transplantation (LT) requires further study. The aim of this work was therefore to compare the utility of physiological reserve measures in predicting early adverse clinical outcomes post-LT. Methods: A single-center, retrospective cohort study of LT patients consecutively recruited between 1 January 2015, and 31 August 2020. Outcomes measured were sepsis and death within 12 months of LT, hospital length of stay (LOS), and intensive care LOS. Physiological reserve measures were handgrip strength, mid-arm muscle circumference, and cardiopulmonary exercise testing (CPET) measures. Analysis was performed using univariate and multivariate logistic regression for sepsis and death, and univariate and multivariate Cox regression for hospital and intensive care LOS. Results: Data were obtained for 109 subjects. Patients were predominantly (64%) male with a median (interquartile range [IQR]) age of 57 (49–63) and median (IQR) Model for End-Stage Liver Disease score of 16 (11–21). In multivariate analysis, the odds of sepsis were lower in patients in the highest versus lowest tertile (odds ratio = 0.004; 95% confidence interval [CI] 0.00–0.13; P = 0.002). Hospital LOS was linearly associated with handgrip strength (hazard ratio [HR] = 1.03; 95% CI 1.00–1.06; P = 0.03) in multivariate analysis. Intensive care LOS was associated with peak VO2 (HR 1.83; 95% CI 1.06–3.16; P = 0.03) and VE/VCO2 slope (HR 0.71; 95% CI 0.58–0.88; P = 0.002) in multivariate analysis. Conclusion: Handgrip strength and CPET both identify candidates at high risk of adverse outcomes after LT.

Original languageEnglish
Pages (from-to)132-138
Number of pages7
JournalJGH Open
Issue number2
Early online date12 Jan 2022
Publication statusPublished - Feb 2022


  • Physiological
  • Liver
  • Transplantation
  • handgrip strength
  • intensive care length of stay
  • hospital length of stay
  • cardiopulmonary exercise testing
  • sepsis


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