Supplement document. Details about KPS categorization in KOTRY data

Supplement document. Details about KPS categorization in KOTRY data

The KOTRY database sorted KPS data into 6 categories for evaluation efficiency: 1) 80–100%, normal social activity, no specialized care required; 2) 70%, unable to work, able to live at home; 3) 50–60%, unable to work, requires occasional assistance at home; 4) 40%, unable to care for self, requires special care and assistance; 5) 20–30%, severely disabled, hospitalization needed; 6) 0–10%, moribund or death.

This categorization is in accordance with the conventional 3 -level KPS classification system of high (80–100%), intermediate (50–70%), and low (0–40%).

Additionally, the KOTRY database further divides the intermediate KPS class (50–70%) according to the need for self-care assistance (70% and 50–60%) and the low KPS class (0–40%) according to the need for hospitalization and fatality status (40%, 20–

30%, and 0–10%).

Figure S1. Causes of death.

Figure S2. Patient survival probability when the control group was divided in to

improved and no change of KPS.

Tables S1. Results of uni- and multivariable Cox regression for patient survival.

Univariable Multivariable ^†

Variables HR (95% CI) P HR (95% CI) P

2.60 (1.37-4.95) 0.004 2.92 (1.52-5.59) 0.001 1.03 (0.98-1.06) 0.072 1.01 (0.98-1.04) 0.419 0.92 (0.54-1.58) 0.769

0.92 (0.86-0.99) 0.024 0.90 (0.83-0.97) 0.005

Reference

0.8 (0.48-1.35) 0.408 1.02 (0.99-1.04) 0.107 1.01 (0.62-1.64) 0.961 1.01 (0.94-1.09) 0.794 0.99 (0.98-1.01) 0.256 0.85 (0.46-1.54) 0.584

1.77 (1.06-2.98) 0.030 1.60 (0.94-2.75) 0.085 1.24 (0.74-2.06) 0.409

2.97 (0.41-21.39) 0.281 Declined KPS

Age, year Sex, male

Body mass index, kg/m² Year of LT

2014-2016 2017-2018 Donor age, year Donor sex, male Donor BMI, kg/m² GRWR, per 0.1%

ABO incompatibility Hypertension Pretransplant DM Retransplantation Underlying liver disease

Viral Reference

Alcohol 0.65 (0.35-1.22) 0.180

Others 0.57 (0.25-1.33) 0.193

0.99 (0.96-1.02) 0.539 Pretransplant MELD

Pretransplant HCC

No HCC Reference Referece

Within Milan HCC 1.41 (0.78-2.53) 0.253 1.41 (0.78-2.56) 0.257 Above Milan HCC 5.72 (3.22-10.17) <0.001 6.04 (3.34-10.91) <0.001 Immunosupressants at 1

month

TAC and MMF Reference

TAC and EVR 1.59 (0.57-4.41) 0.372

TAC 1.13 (0.64-1.99) 0.671

Others 1.08 (0.26-4.43) 0.919

Steroid use at 1 month 0.64 (0.34-1.22) 0.177 Laboratory tests at 1 month

AST, U/L 0.99 (0.99-1.01) 0.806

ALT, U/L 0.99 (0.99-1) 0.871

Total bilirubin, mg/dL 0.94 (0.74-1.19) 0.624

Cr, mg/ dL 1.25 (0.97-1.60) 0.082 1.25 (0.97-1.60) 0.081

KPS score at 1 month

80-100% Reference

70% 1.14 (0.66-1.99) 0.639

50-60% 1.54 (0.80-2.97) 0.196

40% 1.75 (0.72-4.26) 0.220

Events between 1 and 6 months

Rejection 0.42 (0.06-2.99) 0.383

Infection 1.30 (0.65-2.62) 0.459

Bile duct complication 1.15 (0.55-2.40) 0.708 Vascular complication 0.72 (0.10-5.2) 0.747

Figure S3. Survival analyses stratified by degree of KPS decline.

Moderately declined KPS : 1 KPS category dropped in KOTRY data

Severely declined KPS : more than 2 KPS category dropped in KOTRY data

Tables S2. Results of uni- and multivariable logistic regression for declined KPS

between 1 and 6 months after LDLT

Tables S3. Results of uni- and multivariable logistic regression for declined KPS between 1 and 6 months after LDLT

Univariable Multivariable ^†

Variables HR (95% CI) P HR (95% CI) P

0.99 (0.98-1.01) 0.356

1.39 (1.01-1.89) 0.042 1.41 (0.98-1.97) 0.062 1.00 (0.95-1.04) 0.863

Reference

1.30 (0.95-1.80) 0.101 1.01 (0.99-1.02) 0.450 0.94 (0.69-1.28) 0.705 1.01 (0.97-1.06) 0.597 1.12 (0.78-1.58) 0.517 0.96 (0.65-1.38) 0.823 1.05 (0.75-1.46) 0.761 0.89 (0.05-4.43) 0.911 1.48 (0.92-1.87) 0.218 Age, year

Sex, female

Body mass index, kg/m² Year of LT

2014-2016 2017-2018 Donor age, year Donor sex, male Donor BMI, kg/m² GRWR, per 0.1%

ABO incompatibility Hypertension Pretransplant DM Retransplantation Underlying liver disease

Viral Reference

Alcohol 1.10 (0.77-1.55) 0.591

Others 1.22 (0.79-1.85) 0.350

0.99 (0.97-1.01) 0.422 Pretransplant MELD

Pretransplant HCC

No HCC Reference

Within Milan HCC 0.92 (0.67-1.26) 0.615 Above Milan HCC 0.90 (0.53-1.45) 0.676 Albumin, mg/dL 0.93 (0.73-1.18) 0.567 Retractable ascites 0.99 (0.67-1.42) 0.958 Encephalopathy, grade  3 1.00 (0.24-2.80) 0.996 Hospital stay  21 days 0.98 (0.73-1.32) 0.884 Immunosupressants at 1

month

TAC and MMF Reference

TAC and EVR 0.10 (0.09-1.28) 0.971

TAC 0.88 (0.60-1.26) 0.502

Others 1.39 (0.57-2.88) 0.423

Steroid use at 1 month 1.94 (1.07-3.97) 0.046 1.83 (0.96-3.89) 0.087 Laboratory tests at 1 month

AST, U/L 1.00 (1.00-1.00) 0.951

ALT, U/L 1.00 (1.00-1.00) 0.297

Total bilirubin, mg/dL 1.01 (0.90-1.10) 0.832

Cr, mg/ dL 1.01 (0.78-1.24) 0.935

KPS score at 1 month

70% Reference Reference

80-100% 3.11 (2.23-4.38) <0.001 5.67 (3.86-8.50) <0.001

50-60% 0.53 (0.25-1.00) 0.066 0.32 (0.14-0.64) 0.002

40% 1.58 (0.74-3.05) 0.200 1.16 (0.51-2.39) 0.710

Events between 1 and 6 months

Rejection 4.53 (2.72-7.32) 0.001 5.06 (2.74-9.09) <0.001 Infection 3.77 (2.66-5.30) 0.001 3.52 (2.27-5.41) <0.001 Bile duct complication 5.35 (3.85-7.39) 0.001 5.52 (3.72-8.18) <0.001 Vascular complication 3.43 (1.71-6.36) 0.001 3.38 (1.50-7.13) 0.002

Table S4. Baseline characteristics among patients who experienced posttransplant complication

Variables Declined KPS

(n = 111)

Control

(n = 478)

P-Value

Baseline characteristics

Age, years 56.0 (49.5-60.5) 55.0 (50.0-61.0) 0.760

Sex, female 33 (29.7) 140 (29.3) 1.000

BMI, kg/m

²

23.8 (21.5-26.2) 23.6 (21.6-26.1) 0.626

Year of LT, 2017–2018 85 (76.6) 311 (65.1) 0.027

Donor age, years 31.0 (23.0-39.0) 32.0 (24.0-43.0) 0.450

Donor sex, female 42 (37.8) 178 (37.2) 0.993

Donor BMI, kg/m

²

24.0 (22.0-26.0) 23.0 (21.0-25.0) 0.173

Graft-recipient weight ratio, % 1.0 (0.9–1.2) 1.1 (0.9–1.3) 0.173

ABO incompatibility 28 (25.2) 109 (22.8) 0.675

Hypertension 24 (21.6) 94 (19.7) 0.740

Pretransplantation diabetes mellitus 34 (30.6) 148 (31.0) 1.000

Retransplantation 1 (0.9) 5 (1.0) 1.000

Underlying liver disease, alcohol 27 (24.3) 120 (25.1) 0.985 Pretransplantation MELD 12.0 (8.0-17.0) 13.0 (9.0-20.0) 0.250

Pretransplantation HCC 59 (53.1) 239 (50.0 0.755

Albumin, mg/dL 3.4 (2.9-3.6) 3.2 (2.8-3.7) 0.999

Retractable ascites 27 (24.3) 108 (22.6) 0.889

Encephalopathy, grade > 3 3 (2.7) 6 (1.3) 0.200

Hospital stay, days 21.0 (16.0-25.0) 23.0 (19.0-34.0) <0.001

Table S5. Subclasses of complications among patients who experienced post transplant complication

Variables Declined KPS

(n = 111)

Control

(n = 478)

P-Value

Rejection, completely rescued 13 (11.7) 68 (14.2) 0.589

Rejection, not completely rescued 10 (9.0) 7 (1.5) <0.001

Infection, bacterial 45 (40.5) 144 (30.1) 0.045

Infection, viral 14 (12.6) 91 (19.0) 0.145

Infection, fungal and PJP 6 (5.4) 11 (2.3) 0.148

Bile duct complication, no procedure

or surgery 3 (2.7) 8 (1.7) 0.740

Bile duct complication, need

procedure or surgery 65 (58.6) 233 (48.7) 0.079

Vascular complication, no procedure

or surgery 1 (0.9) 11 (2.3) 0.811

Vascular complication, need

procedure or surgery 9 (8.1) 33 (6.9) 0.570

Figure S4. Trend of KPS though out study period in the study groups.

Figure S5. Trend of KPS thoughout study period in the study groups.