Liver and Bile
Hepatology. 2022;75(6):1471–9
Frailty, mortality, and health care utilization after liver transplantation: From the Multi-Center Functional Assessment in Liver Transplantation (FrAILT) Study
Background and aims: Frailty is a well-established risk factor for poor outcomes in patients with cirrhosis awaiting liver transplantation (LT), but whether it predicts outcomes among those who have undergone LT is unknown.
Approach and results: Adult LT recipients from 8 US centers (2012–2019) were included. Pre-LT frailty was assessed in the ambulatory setting using the Liver Frailty Index (LFI). “Frail” was defined by an optimal cut point of LFI ≥ 4.5. The authors used the 75th percentile to define “prolonged” post-LT length of stay (LOS; ≥ 12 days), intensive care unit (ICU) days (≥ 4 days), and inpatient days within 90 post-LT days (≥ 17 days). Of 1166 LT recipients, 21% were frail pre-LT. Cumulative incidence of death at 1 and 5 years was 6% and 16% for frail and 4% and 10% for non-frail patients (overall log-rank p = 0.02). Pre-LT frailty was associated with an unadjusted 62% increased risk of post-LT mortality (95% confidence interval [CI]: 1.08–2.44); after adjustment for body-mass index, hepatocellular carcinoma, donor age, and donation after cardiac death status, the hazard ratio (HR) was 2.13 (95% CI: 1.39–3.26). Patients who were frail versus non-frail experienced a higher adjusted odds of prolonged LT LOS (odds ratio [OR] = 2.00; 95% CI: 1.47–2.73), ICU stay (OR = 1.56; 95% CI: 1.12–2.14), inpatient days within 90 post-LT days (OR = 1.72; 95% CI: 1.25–2.37), and non-home discharge (OR = 2.50; 95% CI: 1.58–3.97).
Conclusions: Compared with non-frail patients, frail liver transplantation (LT) recipients had a higher risk of post-LT death and greater post-LT health care utilization, although overall post-LT survival was acceptable. These data lay the foundation to investigate whether targeting pre-LT frailty will improve post-LT outcomes and reduce resource utilization.