Physical frailty after liver transplantation |
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| Authors: | Jennifer C. Lai Dorry L. Segev Charles E. McCulloch Kenneth E. Covinsky Jennifer L. Dodge Sandy Feng |
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| Affiliation: | 1. Department of Medicine, Division of Gastroenterology and Hepatology, University of California‐San Francisco, San Francisco, CA, USA;2. Department of Surgery, Division of Transplantation, Johns Hopkins Medical Institute, Baltimore, MD, USA;3. Department of Epidemiology and Biostatistics, University of California‐San Francisco, San Francisco, CA, USA;4. Department of Medicine, Division of Geriatrics, University of California‐San Francisco, San Francisco, CA, USA;5. Department of Surgery, University of California‐San Francisco, San Francisco, CA, USA |
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| Abstract: | Frailty is prevalent in liver transplant candidates, but little is known of what happens to frailty after liver transplantation. We analyzed data for 214 adult liver transplant recipients who had ≥1 frailty assessment using the Liver Frailty Index (LFI) at 3‐ (n = 178), 6‐ (n = 139), or 12‐ (n = 107) months posttransplant (higher values=more frail). “Frail” and “robust” were defined as LFI ≥4.5 and <3.2. Median pre–liver transplant LFI was 3.7, and was worse at 3 months (3.9; P = .02), similar at 6 months (3.7; P = .07), and improved at 12 months (3.4; P < .001). The percentage who were robust pre‐ and 3‐, 6‐, and 12‐months posttransplant were 25%, 14%, 28%, and 37%; the percentage frail were 21%, 21%, 10%, and 7%. In univariable analysis, each 0.1 pretransplant LFI point more frail was associated with a decreased odds of being robust at 3‐ (odds ratio [OR] 0.75), 6‐ (OR 0.77), and 12‐months (OR 0.90) posttransplant (P ≤ .001), which did not change substantially with multivariable adjustment. In conclusion, frailty worsens 3 months posttransplant and improves modestly by 12 months, but fewer than 2 of 5 patients achieve robustness. Pretransplant LFI was a potent predictor of posttransplant robustness. Aggressive interventions aimed at preventing frailty pretransplant are urgently needed to maximize physical health after liver transplantation. |
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| Keywords: | clinical research/practice comorbidities geriatrics liver transplantation/hepatology nutrition patient characteristics quality of life (QOL) rehabilitation |
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