Frailty in Liver Transplantation: A Comprehensive Review

Abstract

Frailty, a global impairment of multiple organ systems resulting in increased vulnerability to health stressors, is common in end-stage liver disease, multifactorial in etiology, and impacts overall mortality as well as outcomes in liver transplantation. This is a review of the currently available data, a synopsis of expert consensus, and a framework for transplant centers to approach frailty. We suggest that centers use a multidisciplinary team of healthcare providers and approach frailty in a programmatic fashion to provide effective patient care and ensure optimal transplant outcomes. The utilization of standardized protocols to address both malnutrition and physical debility is ideal and can help ensure safety. A toolbox of resources has been made available by experts in the field to facilitate this approach. The incorporation of new technology tailored to overcome barriers is another resource under investigation.

Comparing Functional Frailty and Radiographic Sarcopenia as Predictors of Outcomes After Liver Transplant

“…First, many of the etiologies that drive patients to require liver transplants also contribute to muscle wasting, such as chronic inflammation, hepatic synthetic dysfunction, ascites, catabolic overdrive, and improper ammonia processing [58]. Secondly, the median wait time for liver transplant recipients ages 50-64 yearsold is over 1000 days (based on OPTN data as of April 15, 2022 from liver competing risk median waiting time to deceased donor transplant for registrations listed: 2011-2014), providing a window to start frailty interventions like nutritional supplementation, muscle building exercises, hormone treatment, or other indicated therapies [59,60]. Fortunately, the multiple clinical evaluations to be listed and then maintain status on a transplant waitlist provide opportunities to assess and intervene on frailty.…”

Fueling the success of transplantation through nutrition: recent insights into nutritional interventions, their interplay with gut microbiota and cellular mechanisms

“…Frailty is a multidimensional condition resulting from age-related declines in physical, cognitive, physiological and immune reserves [53]. Therefore, frailty is highly prevalent among patients with solid organ transplantations and is independently associated with a number of adverse outcomes including an increased mortality, postoperative complications, delayed graft function and prolonged hospitalization [54][55][56][57][58]. As the end stage of malnutrition and sarcopenia contribute to frailty, its multidimensional assessment is necessary.…”

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“…Todos los pacientes programados para THO se les debe de realizar una evaluación de su fragilidad, por que, se ha demostrado que el grado de fragilidad impacta directamente en la mortalidad 95 . La fragilidad se puede definir como un síndrome multidimensional caracterizado por una disminución en las reservas funcionales que deja al paciente vulnerable a resultados adversos debido a la disminución de tolerancia a factores estresantes 96 . Es una construcción multidimensional representando la manifestación final de alteraciones en múltiples sistemas fisiológicos (sistemas inflamatorio, endocrino, cognitivo y musculoesquelético), así como factores psicosociales 97 .…”