How a common hospital tool predicts poor outcomes after liver transplants

A frequently used tool in the hospital can be an indicator of which liver transplant recipients will do poorly after surgery, according to new research from Cedars-Sinai Medical Center.

Led by Vinay Sundaram, a team of researchers found that the nursing assessment called the Braden Scale could be put to use in liver transplant patients as well. The Braden Scale is required by Medicare and Medicaid to be used to evaluate if newly admitted patients need extra care to prevent pressure ulcers or bedsores from worsening. The ratings are used on patients’ activity levels, mobility, nutrition and other measures of frailty. If they score low, it is usually an indicator of greater frailty and a higher risk of bedsores.

According to the American Liver Foundation, about 6,000 liver transplants happen annually in the U.S. There are 17,000 people who are currently waiting to have a transplant.

The researchers used the medical records of 341 liver transplant patients at Cedars-Sinai and the Oregon Health and Science University in Portland and found that liver transplant patients who had a low Braden Scale score were more likely to be nonambulatory at discharge, be discharged to rehabilitation facilities or have a longer hospital stay compared to transplant patients with higher scores.

“With medical advances in recent decades, liver transplant patients are living longer than ever,” Sundaram said in a press release. “So doctors are rightly turning their attention to improving quality of life. The problem is that we have no good way to measure how well these patients will do. Our findings provide a way to achieve that so that we can take preventive action.”

The researchers also suggest that patients who have low Braden Scale scores should be put on supervised exercise programs after their procedures.

“These programs could improve physical functioning and, ultimately, quality of life,” said Sundaram.

Sundaram hopes to sample a larger group of transplant patients to see if the Braden Scale works.

The research was published in the journal Liver Transplantation.

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