Frailty, Physical Performance and Sarcopenia Measures in Patients Awaiting Liver Transplantation Predict Mortality and Post-Operative Complications.

The Role of Sarcopenia and Frailty in Hepatic Encephalopathy Management

“…26 In our center, 82 patients with cirrhosis listed for transplantation were examined prospectively for elements of frailty. 35 Patients who were deemed to be frail by the Fried Frailty Index had a higher incidence of a composite outcome of post-transplant death, re-operation or infection (66% in frail patients vs 26% in nonfrail patients, P 5 .008). In this cohort, physical measures such as walk speed and the short physical performance battery were the most predictive of important clinical outcomes, including pre-liver transplantation and overall mortality.…”

“…Application of this scoring system to patients with advanced liver disease and HE may overestimate frailty, as this patient population is less likely to engage in physical activity and more apt to report exhaustion; however, this scale has now been used in studies evaluating morbidity and mortality in patients listed for liver transplantation. 6,35 …”

“…A similar numerical difference was seen in a smaller cohort of 82 patients on the transplant wait list evaluated with the Fried Frailty Index, in which 65% of frail patients had a history of overt HE compared with 46% of controls (P 5 .10). 35 …”

Frailty in advanced liver disease

“…However, organ shortage presents a major limitation in most parts of the world and is responsible for long waitlists and a large proportion of waitlist mortality. As aforementioned, frailty significantly increases the risk of waitlist mortality and/or delisting independent of MELD scores . The postoperative recovery after LT surgery is often complicated, with a 5%‐10% mortality rate in the early post‐transplant period, and this risk is increased further by frailty.…”

“…The risk of post‐transplant mortality correlates with baseline aerobic capacity in patients with advanced liver failure and frailty scores at the time of LT in HIV‐positive patients . A prospective study of cirrhotic patients undergoing LT found that frailty conferred a significant increase in the composite end‐point of postoperative mortality, infection and reoperation (66% vs 26% in nonfrail patients, P = 0.008) . In a cohort of HIV‐positive patients, post‐LT mortality risk and nonoptimal transplant outcome also correlate with degree of change in frailty scores from pre‐ to post‐transplant (mortality: hazard ratio 1.10, P = 0.006 at 1‐year post‐transplant; nonoptimal outcome: hazard ratio 1.04, P = 0.01).…”