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Improving frailty in patients with cirrhosis listed for LT reduces mortality

BOSTON — Improvements in frailty among patients with cirrhosis awaiting liver transplantation lowered the risk for mortality regardless of baseline frailty and MELD-Na score, according to data presented at The Liver Meeting 2019.

“Of the many studies out there on frailty in patients with cirrhosis, they’ve been limited by the fact that frailty has been measured at a single time point and, while that’s entirely valid, we as clinicians know that frailty is rather dynamic,” Jennifer Cindy Lai, MD, University of California, San Francisco, said during her presentation. “So, we wanted to better understand what the patterns in changes in patients with cirrhosis were, and how do these patterns in changes associate with death.”

Lai and colleagues analyzed 2,851 visits from 1,093 adults with cirrhosis listed for liver transplantation without hepatocellular carcinoma using the Liver Frailty Index (LFI) at baseline and follow-up visits.

They categorized patients by change in frailty over time per 3 months as steep worsening (16%), moderate worsening (23%), minimal worsening (35%), or improving (26%). Lai noted that at 3 months, the median change in LFI was 0.1, which she said showed that “most patients with cirrhosis are quite stable in this period and there is not the linear decline that one might expect.”

The cumulative incidence of waitlist mortality increased in the improving group from 0.6% at 6 months to 1.2% at 12 months and to 7.3% at 24 months. During those same three time points, mortality increased in the minimal group from between 7% and 10% to 17.3%, in the moderate group from between 8.4% and 17.2% to 22.6%, and in the steep worsening group from between 12.1% and 22.5% to 35.4%.

The average change in LFI was a 0.7 increase in those with severe worsening frailty and a 0.5 decrease in those who improved.

Multivariate analysis adjusted for age, height, MELD-Na and albumin showed that a 0.1 unit change in both LFI (subharzard ratio = 1.07; 95% CI, 1.05-1.1) and change in liver frailty per 3 months (sHR = 2.04; 95% CI, 1.35-3.09) correlated with death and delisting.

“Our data are observational, but they do raise the question: can intentional improvements and interventions in frailty reduce the risk for death?” Lai said. “We from the multicenter frailty study believe very strongly that these data lay the foundation for interventions targeting frailty to intentionally reduce waitlist mortality in this population. The Liver Frailty Index can be used that a tool to assess response to change. – by Talitha Bennett

Reference: Lai JC. Abstract 0054. Presented at: The Liver Meeting; Nov. 7-12, 2019; Boston.