Frailty linked with mortality after liver transplantation
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Frailty was associated with worse outcomes in patients who underwent liver transplantation, according to research presented at The Liver Meeting Digital Experience.
In her presentation, Jennifer Cindy Lai, MD, from the University of California, San Francisco, said frailty has been recognized as a predictor of mortality among patients on the transplant waitlist.
“What has been less well-established is the association between frailty and mortality after liver transplantation,” she said. “The objective of our study was to evaluate the association between pre-transplant frailty and outcomes after liver transplantation, including mortality and health care utilization.”
Researchers explored how frailty might predict liver transplant outcomes in 908 liver transplant recipients. They assessed frailty in the pre-transplant, outpatient setting using the Liver Frailty Index (LFI) and defined frailty as a LFI score of at least 4.5.
At a median of 2.6 months prior to transplant, patients in the study had a median LFI of 3.9, and 22% met the criteria for frail.
Investigators found that at a median follow-up of 33 months, 80 patients (9%) died. In their analysis, they determined that pre-transplant frailty was associated with a 70% increase in risk for post-transplant death (HR = 1.7; 95% CI, 1.04-2.69). The association remained after adjusting for hepatocellular carcinoma, donor age and other factors (HR = 2.09; 95% CI, 1.28-3.41).
Lai and colleagues also found that the effect of frailty grew with each month increase in time to transplant (ratio of HRs = 1.15).
Patients with frailty prior to transplant also experienced higher rates of prolonged length of stay (37% vs. 22%), ICU days (34% vs. 23%) and inpatient days within 90 days of transplant (33% vs. 24%; all P < .01). Additionally, they had higher rates of death within the transplant hospitalization (4% vs. 2%) and higher rates of non-home discharge (14% vs. 5; P < .001).
Lai said the question they initially set out to find was a frailty threshold at which liver transplantation might futile. However, she said the questions now become which patients with frailty they can transplant safely and effectively, when is the best time to transplant and what resources should be provided to these patients.
“Our data lay the foundation for us to begin answering these questions,” Lai said.
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