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Am J Transplant. 2018 Aug;18(8):1986-1994. doi: 10.1111/ajt.14675. Epub 2018 Mar 13.

Physical frailty after liver transplantation.

Author information

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.

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.

KEYWORDS:

clinical research/practice; comorbidities; geriatrics; liver transplantation/hepatology; nutrition; patient characteristics; quality of life (QOL); rehabilitation

PMID:
29380529
PMCID:
PMC6066446
[Available on 2019-08-01]
DOI:
10.1111/ajt.14675

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