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

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.