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. 2025 Jun 18;15(2):98228.
doi: 10.5500/wjt.v15.i2.98228.

Effect of frailty as measured by functional impairment on long-term outcomes in liver transplantation in the United States

Julius Balogh  1 , Talha Mubashir  1 , Yuan Li  2 , Biai D Digbeu  2 , Nikita Hegde  3 , Fatemeh Movaghari Pour  4 , Mohsen Rezapour  5 , Hong-Yin Lai  2 , Kelly West  6 , Rabail A Chaudhry  7 , George W Williams  6 , Vahed Maroufy  8
Affiliations

Effect of frailty as measured by functional impairment on long-term outcomes in liver transplantation in the United States

Julius Balogh et al. World J Transplant. .

Abstract

Background: In patients with chronic liver disease or hepatic dysfunction with sarcopenia, there is an increased risk of frailty as measured by functional impairment, making frailty a vital predictor of post-transplant mortality.

Aim: To investigate the effects of frailty on mortality after liver transplantation.

Methods: A retrospective review of post-transplant outcomes in liver transplant recipients assessed frailty using Karnofsky Performance Score. Data from the Scientific Registry of Transplant Recipients database for 37427 liver transplant recipients was used.

Results: Of 82.7% frail patients, 42.7% were severely frail and 40% were moderately frail (P < 0.001) at the time of transplantation. Compared with non-frail patients, post-transplant mortality in frail patients was significantly higher at 12 months [odds ratio (OR) = 1.94, P = 0.02)]. Secondary analysis of the data revealed that liver grafts from donation after circulatory death (DCD) were more likely to be associated with frail patients at transplant (OR = 1.86, P < 0.001). Furthermore, a donor history of hypertension was associated with a lower likelihood of frailty in the recipient at the time of transplant (OR = 0.65, P = 0.03).

Conclusion: Recipient frailty is associated with increased mortality at 12 months following liver transplantation, and liver transplants from donors with DCD are associated with increased frailty of the liver transplant recipient.

Keywords: Alcohol-associated liver disease; Insulin resistance; Liver transplantation; Non-alcoholic steatohepatitis; Non-alcoholic steatotic liver disease; Oxidative stress.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflict of interests.

Figures

Figure 1
Figure 1
Trend of odds ratios of mortality. The trend for the association of odds ratios of mortality with model for end-stage liver disease score (left) and Frailty (right) for different models with mortality within 1-12 months. MELD: Model for end-stage liver disease; OR: Odds ratio.
Figure 2
Figure 2
Survival curves 1-12 months. The survival curves within the first 12 months following liver transplant for the two frailty subgroups are presented.
See this image and copyright information in PMC

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