These data suggest that the development and implementation of a culturally congruent transplant program can positively affect Hispanic LDKT and thereby reduce Hispanics disparities in LDKT rates. Further studies are needed to prospectively evaluate the generalizability of implementing such culturally competent interventions at other transplant programs.

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. We 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 nonfrail patients (overall log‐rank p = 0.02). Pre‐LT frailty was associated with an unadjusted 62% increased risk of post‐LT mortality (95% CI, 1.08–2.44); after adjustment for body mass index, HCC, donor age, and donation after cardiac death status, the HR was 2.13 (95% CI, 1.39–3.26). Patients who were frail versus nonfrail experienced a higher adjusted odds of prolonged LT LOS (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 nonhome discharge (OR, 2.50; 95% CI, 1.58–3.97). Conclusions Compared with nonfrail patients, frail 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.

Background & Aims Cirrhosis leads to malnutrition and muscle wasting that manifests as frailty, which may be influenced by cirrhosis aetiology. We aimed to characterize the relationship between frailty and cirrhosis aetiology. Methods Included were adults with cirrhosis listed for liver transplantation (LT) at 10 US centrer who underwent ambulatory testing with the Liver Frailty Index (LFI; ‘frail’ = LFI ≥ 4.4). We used logistic regression to associate aetiologies and frailty, and competing risk regression (LT as the competing risk) to determine associations with waitlist mortality (death/delisting for sickness). Results Of 1,623 patients, rates of frailty differed by aetiology: 22% in chronic hepatitis C, 31% in alcohol‐associated liver disease (ALD), 32% in non‐alcoholic fatty liver disease (NAFLD), 21% in autoimmune/cholestatic and 31% in ‘other’ (P < .001). In univariable logistic regression, ALD (OR 1.53, 95% CI 1.12‐2.09), NAFLD (OR 1.64, 95% CI 1.18‐2.29) and ‘other’ (OR 1.58, 95% CI 1.06‐2.36) were associated with frailty. In multivariable logistic regression, only ALD (OR 1.40; 95% 1.01‐1.94) and ‘other’ (OR 1.59; 95% 1.05‐2.40) remained associated with frailty. A total of 281 (17%) patients died/were delisted for sickness. In multivariable competing risk regression, LFI was associated with waitlist mortality (sHR 1.05, 95% CI 1.03‐1.06), but aetiology was not (P > .05 for each). No interaction between frailty and aetiology on the association with waitlist mortality was found (P > .05 for each interaction term). Conclusions Frailty is more common in patients with ALD, NAFLD and ‘other’ aetiologies. However, frailty was associated with waitlist mortality independent of cirrhosis aetiology, supporting the applicability of frailty across all cirrhosis aetiologies.