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Frailty and Outcomes After Liver Transplantation

  • Elliot B. TapperEmail author
Frailty and Gerontology (M McAdams Demarco, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Frailty and Gerontology

Abstract

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.

Recent Findings

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).

Summary

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.

Keywords

Liver disease Cirrhosis Portal hypertension Hepatic encephalopathy 

Notes

Funding

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.

Disclosure

Elliot Tapper is the guarantor of this article.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Child CG. Surgery and portal hypertension. The liver and portal hypertension. 1964.Google Scholar
  2. 2.
    Lai JC, Covinsky KE, Hayssen H, Lizaola B, Dodge JL, Roberts JP, et al. Clinician assessments of health status predict mortality in patients with end-stage liver disease awaiting liver transplantation. Liver Int. 2015;35(9):2167–73.CrossRefGoogle Scholar
  3. 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. 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
  5. 5.
    Lai JC, Covinsky KE, Dodge JL, Boscardin WJ, Segev DL, Roberts JP, et al. Development of a novel frailty index to predict mortality in patients with end-stage liver disease. Hepatology. 2017;66(2):564–74.CrossRefGoogle Scholar
  6. 6.
    Lai JC, Feng S, Terrault N, Lizaola B, Hayssen H, Covinsky K. Frailty predicts waitlist mortality in liver transplant candidates. Am J Transplant. 2014;14(8):1870–9.CrossRefGoogle Scholar
  7. 7.
    Samoylova ML, Covinsky KE, Haftek M, Kuo S, Roberts JP, Lai JC. Disability in patients with end-stage liver disease: results from the functional assessment in liver transplantation study. Liver Transpl. 2017;23(3):292–8.CrossRefGoogle Scholar
  8. 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
  9. 9.
    Tandon P, Tangri N, Thomas L, Zenith L, Shaikh T, Carbonneau M, et al. A rapid bedside screen to predict unplanned hospitalization and death in outpatients with cirrhosis: a prospective evaluation of the clinical frailty scale. Am J Gastroenterol. 2016;111(12):1759–67.CrossRefGoogle Scholar
  10. 10.
    Orman ES, Ghabril M, Chalasani N. Poor performance status is associated with increased mortality in patients with cirrhosis. Clin Gastroenterol Hepatol. 2016;14(8):1189–1195.e1.CrossRefGoogle Scholar
  11. 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
  12. 12.
    Dolgin NH, Martins PN, Movahedi B, Lapane KL, Anderson FA, Bozorgzadeh A. Functional status predicts postoperative mortality after liver transplantation. Clin Transpl. 2016;30(11):1403–10.CrossRefGoogle Scholar
  13. 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
  14. 14.
    Sundaram V, Lim J, Tholey DM, Iriana S, Kim I, Manne V, et al. The Braden scale, a standard tool for assessing pressure ulcer risk, predicts early outcomes after liver transplantation. Liver Transpl. 2017;23:1153–60.CrossRefGoogle Scholar
  15. 15.
    Sinclair M, Poltavskiy E, Dodge JL, Lai JC. Frailty is independently associated with increased hospitalisation days in patients on the liver transplant waitlist. World J Gastroenterol. 2017;23(5):899–905.CrossRefGoogle Scholar
  16. 16.
    Carey EJ, Steidley DE, Aqel BA, Byrne TJ, Mekeel KL, Rakela J, et al. Six-minute walk distance predicts mortality in liver transplant candidates. Liver Transpl. 2010;16(12):1373–8.CrossRefGoogle Scholar
  17. 17.
    Yadav A, Chang YH, Carpenter S, Silva AC, Rakela J, Aqel BA, et al. Relationship between sarcopenia, six-minute walk distance and health-related quality of life in liver transplant candidates. Clin Transpl. 2015;29(2):134–41.CrossRefGoogle Scholar
  18. 18.
    Faustini Pereira JL, Galant LH, Rossi D, da Rosa T, Henrique L, Garcia E, et al. Functional capacity, respiratory muscle strength, and oxygen consumption predict mortality in patients with cirrhosis. Can J Gastroenterol Hepatol. 2016;2016:1–6.CrossRefGoogle Scholar
  19. 19.
    Dunn MA, Josbeno DA, Tevar AD, Rachakonda V, Ganesh SR, Schmotzer AR, et al. Frailty as tested by gait speed is an independent risk factor for cirrhosis complications that require hospitalization. Am J Gastroenterol. 2016;111(12):1768–75.CrossRefGoogle Scholar
  20. 20.
    Bernal W, Martin-Mateos R, Lipcsey M, Tallis C, Woodsford K, Mcphail MJ, et al. Aerobic capacity during cardiopulmonary exercise testing and survival with and without liver transplantation for patients with chronic liver disease. Liver Transpl. 2014;20(1):54–62.CrossRefGoogle Scholar
  21. 21.
    Ney M, Haykowsky M, Vandermeer B, Shah A, Ow M, Tandon P. Systematic review: pre-and post-operative prognostic value of cardiopulmonary exercise testing in liver transplant candidates. Aliment Pharmacol Ther. 2016;44(8):796–806.CrossRefGoogle Scholar
  22. 22.
    Serper M, Bittermann T, Rossi M, Goldberg DS, Thomasson AM, Olthoff KM, et al. Functional status, healthcare utilization, and the costs of liver transplantation. Am J Transplant. 2018;18(5):1187–96.CrossRefGoogle Scholar
  23. 23.
    Thuluvath PJ, Thuluvath AJ, Savva Y. Karnofsky performance status before and after liver transplantation predicts graft and patient survival. J Hepatol. 2018;69:818–25.CrossRefGoogle Scholar
  24. 24.
    Derck JE, Thelen AE, Cron DC, Friedman JF, Gerebics AD, Englesbe MJ, et al. Quality of life in liver transplant candidates: frailty is a better indicator than severity of liver disease. Transplantation. 2015;99(2):340–4.CrossRefGoogle Scholar
  25. 25.
    Cron D, Friedman J, Winder G, Thelen A, Derck J, Fakhoury J, et al. Depression and frailty in patients with end-stage liver disease referred for transplant evaluation. Am J Transplant. 2016;16(6):1805–11.CrossRefGoogle Scholar
  26. 26.
    Dharancy S, Lemyze M, Boleslawski E, Neviere R, Declerck N, Canva V, et al. Impact of impaired aerobic capacity on liver transplant candidates. Transplantation. 2008;86(8):1077–83.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Gastroenterology and HepatologyUniversity of MichiganAnn ArborUSA
  2. 2.Gastroenterology SectionVA Ann Arbor Healthcare SystemAnn ArborUSA

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