title: Frailty predicts waitlist mortality in liver transplant candidates.
abstract: We aimed to determine whether frailty, a validated geriatric construct of increased vulnerability to physiologic stressors, predicts mortality in liver transplant candidates. Consecutive adult outpatients listed for liver transplant with laboratory Model for End-Stage Liver Disease (MELD) ≥ 12 at a single center (97% recruitment rate) underwent four frailty assessments: Fried Frailty, Short Physical Performance Battery (SPPB), Activities of Daily Living (ADL) and Instrumental ADL (IADL) scales. Competing risks models associated frailty with waitlist mortality (death/delisting for being too sick for liver transplant). Two hundred ninety-four listed liver transplant patients with MELD ≥ 12, median age 60 years and MELD 15 were followed for 12 months. By Fried Frailty score ≥3, 17% were frail; 11/51 (22%) of the frail versus 25/243 (10%) of the not frail died/were delisted (p = 0.03). Each 1-unit increase in the Fried Frailty score was associated with a 45% (95% confidence interval, 4-202) increased risk of waitlist mortality adjusted for MELD. Similarly, the adjusted risk of waitlist mortality associated with each 1-unit decrease (i.e. increasing frailty) in the Short Physical Performance Battery (hazard ratio 1.19, 95% confidence interval 1.07-1.32). Frailty is prevalent in liver transplant candidates. It strongly predicts waitlist mortality, even after adjustment for liver disease severity demonstrating the applicability and importance of the frailty construct in this population.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, CA.
authors.forename: J C
authors.initials: JC
authors.lastname: Lai
authors.forename: S
authors.initials: S
authors.lastname: Feng
authors.forename: N A
authors.initials: NA
authors.lastname: Terrault
authors.forename: B
authors.initials: B
authors.lastname: Lizaola
authors.forename: H
authors.initials: H
authors.lastname: Hayssen
authors.forename: K
authors.initials: K
authors.lastname: Covinsky
mesh_terms: D000203:Activities of Daily Living; D006233:Persons with Disabilities; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000601:surgery; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D055948:Sarcopenia / Q000628:therapy; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014850:Waiting Lists
keywords: Age; disability; functional status; sarcopenia; surgery