Pre-liver transplant frailty increases risk for worse global functional health outcomes
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Physical frailty before liver transplant correlated with poor functional status and health-related quality of life 1 year after surgery among patients with cirrhosis, according to research published in JAMA Surgery.
“As the quantity of posttransplant years of life improves, it is crucial to better understand the factors, particularly those that are modifiable, that contribute to patients’ quality of life during those posttransplant years,” Jennifer C. Lai, MD, MBA, associate professor of medicine and endowed professor of liver health and transplantation at the University of California, San Francisco, and colleagues wrote. “We previously demonstrated that one of these potentially modifiable factors, frailty, is common and associated with mortality before and after liver transplant. But to our knowledge, whether frailty is also associated with poor health after liver transplant has not yet been investigated.”
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Using data from the Functional Assessment in Liver Transplantation study, Lai and colleagues analyzed 358 patients (median age, 60 years; 32% women; 68% non-Hispanic white) with cirrhosis who underwent LT from October 2016 to February 2020. They assessed patients 1-year posttransplant using Short Form-36, which included physical component summary (PCS) and mental component summary scores (MCS); Instrumental Activities of Daily Living scale and performance-based tests on frailty phenotype and short physical performance.
Studied outcomes evaluated the association between pre- and posttransplant frailty and posttransplant global functional health.
According to results, 19% of patients had frailty prior to LT. One year after LT, patients with frailty had lower median PCS scores compared with patients without frailty (42 vs. 50); both patients groups reported similar median MCS scores (57 vs. 57, respectively).
Univariable analysis revealed pretransplant frailty was associated with a 5.3-lower unit score in posttransplant PCS but not MCS. Further analysis showed frailty also was associated with a higher proportion of patients who reported difficulty with one or more Instrumental Activities of Daily Living (21% vs. 10%) and were unemployed or received disability (39% vs. 29%).
Subgroup analyses of 210 patients who underwent Liver Frailty Index assessment revealed 13% had frailty 1-year after LT; these recipients also had lower adjusted PCS scores, worse median Fried Frailty Phenotype scores (1 [1-2] vs. 1 [0-1]) and higher rates of functional impairment by a Short Physical Performance Battery of 9 or less (42% vs. 20%).
“As the field moves closer to embracing models of transplant care that incorporate how a patient feels and functions, such as co-management with palliative care or transplant survivorship programs, studies that investigate outcomes other than survival alone are needed,” Lai and colleagues concluded. “The study data lay the foundation for interventions and therapeutics that target frailty that are administered before and/or early posttransplant to improve the global functional health in liver transplant recipients.”
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