Multidimensional frailty assessment of liver transplant recipients with long term follow-up (>20 years): preliminary results of the RESIST study an ELITA/ELTR project

Background

chronic exposure to immunosuppressants may accelerate aging in ways not reflected by chronological age. Frailty may be considered a surrogate of biological age and can be assessed using a multidimensional frailty index which explores various deficits across liver function, functional status, cognition, comorbidities and physical performance.

Aims

to assess the multidimensional frailty of adult liver transplant (LT) recipients surviving longer than 20 years compared with the results obtained in the general population of similar age and gender, and to assess the impact of frailty on Quality of Life (QoL).

Methods

we conducted a multicenter, cross-sectional study comparing frailty and QoL of LT patients transplanted before 01/01/2005 and in regular follow-up at different LT Centers, with a control group of non-transplanted subjects of similar age, enrolled in geriatric or hepatological clinics. Frailty was assessed using an updated version of the Frailty Index (FI-39) and now called ELITA FI-35, which is calculated as the ratio of the number of health deficits present in a patient (presence=1, absence=0) with the total number of considered deficits, being 35. QoL was assessed though the auto-administered questionnaire the EQ-5D-5L.

Results

we included 99 LT long-survivor patients compared to 41 controls. Median (IQR) ELITA FI-35 in LT recipients was 0.26 (0.17-0.31) vs. 0.14 (0.11-0.20) in the control group (p <0.001). A moderate correlation was found between age and ELITA FI-35 both for the LT and for the control group (Figure 1), showing a progressive worsening of the score in both group while age increase. The score was significantly different among age categories for the LT group (age<65: 0.14 [0.11, 0.18]; 65<age<75: 0.26 [0.17, 0.31]; age>75: 0.29 [0.23, 0.31], p<0.001). Beyond liver function, the largest differences between cases and controls were observed in physical performance and cognitive domains, particularly: need for help with housekeeping (14% vs. 0%, p=0.03), balance disorders (20% vs. 5%, p=0.04), memory complaints (24% vs. 7%, p=0.4), and insomnia (32% vs. 12%, p=0.03). However, no significant differences were found in QoL measured by the EQ-5D-5L (median [IQR]: 78 [65–85] in LT patients vs. 75 [70–85] in controls, p=0.793), nor in emergency hospital admission rates (30% vs. 20%, p=0.272)

Conclusion

long-term LT recipients showed a higher frailty burden than controls, especially in physical and cognitive domains, with frailty increasing significantly with age. Nevertheless, similar QoL scores between groups suggest that LT recipients maintain a preserved perception of well-being.