PMID- 36691988 OWN - NLM STAT- MEDLINE DCOM- 20230417 LR - 20240502 IS - 1527-6473 (Electronic) IS - 1527-6465 (Print) IS - 1527-6465 (Linking) VI - 29 IP - 5 DP - 2023 May 1 TI - Six-Minute walk distance predicts outcomes in liver transplant candidates. PG - 521-530 LID - 10.1097/LVT.0000000000000071 [doi] AB - A 6-minute walk test is a simple tool for assessing submaximal exercise capacity. We sought to determine whether a 6-minute walk distance (6MWD) predicts outcomes in patients with cirrhosis. The Pulmonary Vascular Complications of Liver Disease 2 study is a multicenter, prospective cohort study that enrolled adults with portal hypertension during liver transplantation evaluation. We excluded subjects with an incident or prevalent portopulmonary hypertension. The 6-minute walk test was performed using standardized methods. Cox proportional hazards modeling and multivariable linear regression analysis were performed to determine the relationship between baseline 6MWD and outcomes. The study sample included 352 subjects. The mean 6MWD was 391+/-101 m. For each 50-meter decrease in 6MWD, there was a 25% increase in the risk of death (HR 1.25, 95% CI [1.11, 1.41], p < 0.001) after adjustment for age, gender, body mass index, MELD-Na, and liver transplant as a time-varying covariate. In a multistate model, each 50-meter decrease in 6MWD was associated with an increased risk of death before the liver transplant ( p < 0.001) but not after the transplant. 6MWD was similar to MELD-Na in discriminating mortality. Each 50-meter decrease in 6MWD was associated with an increase in all-cause ( p < 0.001) and transplant-free hospitalizations ( p < 0.001) in multivariable models for time-to-recurrent events. Shorter 6MWD was associated with worse Short Form-36 physical ( p < 0.001) and mental component scores ( p = 0.05). In conclusion, shorter 6MWD is associated with an increased risk of death, hospitalizations, and worse quality of life in patients evaluated for liver transplantation. The 6-minute walk distance may be a useful adjunct for risk assessment in patients undergoing liver transplant evaluation. CI - Copyright (c) 2023 American Association for the Study of Liver Diseases. FAU - Cox-Flaherty, Katherine AU - Cox-Flaherty K AD - Department of Medicine, Brown University, Providence, Rhode Island, USA. FAU - Moutchia, Jude AU - Moutchia J AD - Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. FAU - Krowka, Michael J AU - Krowka MJ AD - Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA. FAU - Al-Naamani, Nadine AU - Al-Naamani N AD - Department of Medicine, University of Pennsylvania, Philadelphia, USA. FAU - Fallon, Michael B AU - Fallon MB AD - Department of Medicine, University of Arizona, Phoenix, Arizona, USA. FAU - DuBrock, Hilary AU - DuBrock H AD - Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA. FAU - Forde, Kimberly A AU - Forde KA AD - Department of Medicine, Lewis Katz School of Medicine at Temple University, Pennsylvania, USA. FAU - Krok, Karen AU - Krok K AD - Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Pennsylvania, USA. FAU - Doyle, Margaret F AU - Doyle MF AD - Department of Pathology, University of Vermont, Vermont, USA. FAU - Kawut, Steven M AU - Kawut SM AD - Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. AD - Department of Medicine, University of Pennsylvania, Philadelphia, USA. FAU - Ventetuolo, Corey E AU - Ventetuolo CE AD - Department of Medicine, Brown University, Providence, Rhode Island, USA. AD - Health Services, Policy and Practice, Brown University, Providence, Rhode Island, USA. LA - eng GR - R01 HL113988/HL/NHLBI NIH HHS/United States GR - K23 HL141584/HL/NHLBI NIH HHS/United States GR - T32 HL134625/HL/NHLBI NIH HHS/United States GR - R01 HL141268/HL/NHLBI NIH HHS/United States GR - K24 HL103844/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural DEP - 20230125 PL - United States TA - Liver Transpl JT - Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society JID - 100909185 SB - IM MH - Adult MH - Humans MH - *Liver Transplantation/adverse effects MH - Quality of Life MH - Prospective Studies MH - Walk Test MH - *Hypertension, Portal/diagnosis/etiology MH - Exercise Test PMC - PMC10101910 MID - NIHMS1870247 COIS- Conflict of Interest Disclosure: Corey E. Ventetuolo advises and consults for Merck/Acceleron. He advises and received grants from United Therapeutics and Altavant Sciences. He consults for Janssen. Steven M. Kawut consults for and advises United Therapeutics, Acceleron, Vivus, and Janssen. He received "in kind" research support from physIQ. Hilary DuBrock consulting for and advises Janssen. She advises United Therapeutics. She has received grants from Bayer. Karen Krok is on the speakers' bureau for and consults for Gilead. She is on the speakers' bureau for Intecept. She consults for Abbvie. Corey E. Venteuolo consults for Merck/Acceleron and Janssen Pharmaceuticals. EDAT- 2023/01/25 06:00 MHDA- 2023/04/17 06:41 PMCR- 2024/05/01 CRDT- 2023/01/24 05:43 PHST- 2022/10/14 00:00 [received] PHST- 2022/12/06 00:00 [accepted] PHST- 2023/04/17 06:41 [medline] PHST- 2023/01/25 06:00 [pubmed] PHST- 2023/01/24 05:43 [entrez] PHST- 2024/05/01 00:00 [pmc-release] AID - 01445473-202305000-00008 [pii] AID - 10.1097/LVT.0000000000000071 [doi] PST - ppublish SO - Liver Transpl. 2023 May 1;29(5):521-530. doi: 10.1097/LVT.0000000000000071. Epub 2023 Jan 25.