Frailty and Outcomes After Liver Transplantation
Purpose of Review
Frailty is an emerging concept in liver transplantation. We reviewed the literature for the tests of frailty which have been validated to predict outcomes in patients with cirrhosis evaluated for liver transplantation.
Several tools have been developed to further stratify risk of adverse events independent of liver disease severity. These include tests of disability such as activities of daily living and the Karnofsky Performance Score, as well as tests of physical frailty, such as the Liver Frailty Index (handgrip, chair stands, and balance).
Increasingly, the frailty assessment is seen as a critical component of the liver transplant evaluation. Further research is needed to clarify the optimal timing of testing and the implications of longitudinal change.
KeywordsLiver disease Cirrhosis Portal hypertension Hepatic encephalopathy
Elliot Tapper receives funding from the National Institutes of Health through the Michigan Institute for Clinical and Health Research (KL2TR002241).
Compliance with Ethical Standards
Conflict of Interest
Elliot Tapper reports grants from Valeant and Gilead and personal fees from Novartis for a fatty liver disease study.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Elliot Tapper is the guarantor of this article.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Child CG. Surgery and portal hypertension. The liver and portal hypertension. 1964.Google Scholar
- 3.•• Tapper EB, Konerman M, Murphy S, Sonnenday CJ. Hepatic encephalopathy impacts the predictive value of the fried frailty index. Am J Transplant. 2018;18:2566–70 In this prospective cohort study, the prediction of mortality using the frailty phenotype described by Fried in patients with cirrhosis was confounded by a history of hepatic encephalopathy.CrossRefGoogle Scholar
- 4.•• Lai JC, Covinsky KE, McCulloch CE, Feng S. The liver frailty index improves mortality prediction of the subjective clinician assessment in patients with cirrhosis. Am J Gastroenterol. 2018;113(2):235–42 The liver frailty index, a composite of hand-grip, chair-stands, and balance was shown to improve the prediction of mortality over clinician assessments of frailty (eye-ball test) in outpatients listed for liver transplant.CrossRefGoogle Scholar
- 8.• Tapper EB, Finkelstein D, Mittleman MA, Piatkowski G, Lai M. Standard assessments of frailty are validated predictors of mortality in hospitalized patients with cirrhosis. Hepatology. 2015;62(2):584–90 An assessment of activities of daily living provides improved risk-assessment for mortality in a cohort of inpatients with cirrhosis.CrossRefGoogle Scholar
- 11.• Tandon P, Reddy KR, O'leary JG, Garcia-Tsao G, Abraldes JG, Wong F, et al. A Karnofsky performance status–based score predicts death after hospital discharge in patients with cirrhosis. Hepatology. 2017;65(1):217–24 The karnofsky performance status at the time of hospital discharge was associated with improved risk prediction of mortality in a cohort consisting primarily of patients with acute-on-chronic liver failure.CrossRefGoogle Scholar
- 13.Malinis MF, Chen S, Allore HG, Quagliarello VJ. Outcomes among older adult liver transplantation recipients in the model of end stage liver disease (MELD) era. Annals of transplantation: quarterly of the polish transplantation. Society. 2014;19:478.Google Scholar