Simultaneous physical and nutritional intervention reduces frailty in patients with cirrhosis listed for liver transplantation: a randomized controlled trial.

Introduction and objectives: Frailty is associated with an increased morbidity and mortality among patients with cirrhosis. However, no specific treatment strategy has been formally recommended for these patients. This study aims to evaluate the effectiveness of a strategy based on exercise and nutritional intervention improving frailty in cirrhotic patients listed for transplantation.

Patients and methods: Patients with increased Liver Frailty Index (LFI) (≥3.2) were randomized to a control group (standard exercise and nutritional counseling) or intervention group (guided by physical therapist and dietitian) for 12 weeks, LFI was measured, and patients were classified as frail or prefrail. The change in LFI was assessed at the end of study.

Results: Sixty-six patients were included (34 to the control group and 32 to the intervention group), age 59.3 ± 8.8, male 51.5 %, main etiologies: MASLD (40.9 %), ALD (15.2 %), MetALD (6.1 %), PBC (6.1 %), autoimmune hepatitis (4.5 %), MELD Na 17.2 ± 5, Child Pugh A/B/C 13.6 %/57.6 %/28.8 %, Na 137±3 mEq/L, creatinine 0.8 ± 0.3 mg/dL, bilirubin 3.3 ± 3 mg/dL, INR 1.5 ± 0.4, albumin 3.3 ± 0.5 g/dL, LFI 4.23 ± 0.5, frail/prefrail (%) 34.8/65.2. There was a significant improvement in LFI at the end of the study in the intervention group (ΔLFI 0.4 vs ΔLFI 0.14, p = 0.02). Notably, we found a significant reduction in the proportion of frail patients in the intervention group vs control group (28.1 % vs 8.8 %, p = 0.02) at the end of the study.

Conclusions: This randomized controlled trial conducted in patients listed for liver transplantation demonstrates that a dual intervention can effectively reduce frailty in this population.