Frailty Changes After Liver Transplantation. Results From a Spanish Multicenter Prospective Cohort Study

Autores de IIS La Fe

• Lorena Puchades Renau

  Autor

• María Dels Ángels Cebriá Iranzo

  Autor

• Eva María Montalvá Orón

  Autor

• 

  Marina Berenguer Haym

  Autor

Participantes ajenos a IIS La Fe

• Herreras, Julia
• Reyes, Erick
• Crespo, Gonzalo
• Rodriguez-Peralvarez, Manuel
• Cortes, Luis
• Serrano, Trinidad
• Fernandez-Yunquera, Ainhoa

Grupos

• Hepatología, Cirugia Hepatobiliopancreática y Trasplantes

  

  Leader

  Marina Berenguer Haym

• Unidad mixta de investigación en enfermedades raras (CIPF)

  

  Leader

  José María Millán Salvador

Abstract

Introduction.Until now, there has been limited evidence, primarily from US cohorts, focusing on frailty as a patient-oriented outcome after liver transplantation (LT). Our study aimed to explore the relationship between pre- and post-LT frailty in a multicenter European cohort of outpatients with cirrhosis undergoing LT. Methods.We conducted a prospective analysis of data from 180 LT recipients recruited between 2018 and 2020 from 5 Spanish centers. Participants underwent objective and subjective frailty assessments using the Liver Frailty Index (LFI) and the Subjective Clinician Assessment (SCA) pretransplant and at 3- and/or 6-mo posttransplant. Results.The median pretransplant LFI was 3.9, showing minimal change at 3 mo (3.8; P = 0.331) and improvement at 6-mo post-LT (3.6; P = 0.001). Conversely, the SCA significantly improved early post-LT: at 3 mo, poor SCA decreased from 11% to 1%, and good SCA increased from 54% to 89% (P < 0.001), remaining stable between 3- and 6-mo post-LT. Multivariable analysis revealed that each 0.1 increase in pretransplant LFI correlated with a reduced probability of being robust at 3-mo (odds ratio [OR] = 0.75; P < 0.001) and 6-mo post-LT (OR = 0.74; P < 0.001). There was poor concordance between SCA and LFI, with SCA underestimating frailty both pre- and post-LT (Kappa < 0.20). Conclusion.In our European cohort, incomplete improvement of physical frailty was observed, with <20% achieving robust physical condition within 6-mo post-LT. The pretransplant LFI strongly predicted posttransplant frailty. As the SCA tends to overestimate physical function, we recommend using both subjective and objective tools for frailty assessment in LT candidates and recipients.

Copyright © 2024 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.

Keywords

• QUALITY-OF-LIFE; SURGICAL COMPLICATIONS; HEALTH-STATUS; CLASSIFICATION; MORTALITY