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INTRODUCTION:Patients being evaluated for liver transplantation (LT) often suffer from poor health-related quality of life. While several quality measures exist for palliative care in cancer patients, there are limited cirrhosis-specific palliative care tools. The Palliative Performance Scale (PPS) is a prognostication tool that measures a patient’s functional status based on ability to ambulate, activity level, evidence of disease, self-care abilities, oral intake, and level of consciousness, where a patient with a PPS of 100% is functionally healthy. We aim to observe how PPS at initial transplant evaluation relates to patient demographics, decompensation, and transplant outcomes to establish its potential role in the LT population.METHODS:We examined the records of patients who completed LT evaluation at our mid-size liver transplant center. Between March and December 2018, we calculated the PPS as a part of new outpatient LT evaluations. Descriptive statistics were used to evaluate relationships between patient PPS scores and MELD, disease characteristics, and outcomes.RESULTS:Forty-nine patients completed LT evaluation, of which 71% (N = 35) were male and 80% (N = 39) were white. The average age at the time of evaluation was 63. The most common etiology of cirrhosis was NASH (35%, N = 17), followed by alcohol (29%, N = 14), and HCV (25%, N = 12). Among the three most common etiologies, those with alcoholic cirrhosis had the lowest average PPS scores (76), patients with HCV had the highest (90). During the study period, 8 patients were transplanted. Their average PPS at the time of evaluation was 76 compared to 80 among those who were not transplanted. When compared to men, women had a higher MELD (15 vs 13), and lower PPS (74 vs 82). The rates of decompensation among patients with a PPS of 100, 80, and 70 were 55%, 86%, and 93%, respectively.CONCLUSION:This pilot study examines the utility of PPS for patients undergoing LT evaluations, and several trends were elucidated warranting further evaluation. There was not a clear linear relationship between MELD and PPS, indicating that patients with end-stage liver disease have a variable symptom burden even at advanced disease states. The functional status of patients appeared to vary significantly between etiology, gender, and transplantation. Importantly, our data suggests that patients with documented decompensations had lower PPS, indicating a possible role for the PPS to better characterize the functional status and disease burden of these patients.

Anomalies of the inferior vena cava (IVC) are an uncommon finding in the general population. A wide range of IVC anomalies has been described in the literature, the majority of which lack clinical significance. Agenesis of the IVC (AIVC) is a rare anomaly of the IVC in the general population. This anomaly may involve either complete agenesis of the IVC or agenesis of a segment of the IVC. Agenesis of the suprarenal segment is the most commonly occurring variant, while agenesis of the infrarenal and hepatic segments is less common. Here we report a case of agenesis of the intrahepatic segment of the IVC.