Introduction: As frailty correlates with post-transplant outcomes, brief frailty measures are needed in clinical practice to appropriately risk stratify LT candidates. We used an abbreviated version of the frailty scale by Fried et al to examine associations between frailty in liver transplant (LT) candidates, and LT-related healthcare utilization.

Methods: A prospective cohort of 283 LT candidates at a large transplant center from October 2014 to August 2016 was assessed for frailty during outpatient LT evaluation. Frailty was measured on a scale from 0-3 by: 1) BMI-adjusted dynamometer measures of hand grip strength (GS), and by answering questions about: 2) exhaustion ('could not get going' or 'felt that everything was an effort' ≥ 3days per week), and 3) shrinking (loss ≥4.5kg in past year). Median follow-up was 423 days (IQR:122-521). We assessed LT length of stay (LOS), direct LT-associated costs, and post-LT 30-day readmissions, and discharge to rehab.

Results: The median MELD was 12 [IQR: 9-16] and the most common indications for LT evaluation were: Hepatitis C:42%, alcohol:22%, and hepatocellular carcinoma:18%. A total of 35% of patients had reduced GS; 52% reported exhaustion ≥ 3days per week'; 45% met criteria for shrinking; and 26% met all 3 frailty criteria. A total of 64% of patients were waitlisted; 36% were ineligible (of those 5% died, 40% had medical contraindications, 11% had psychosocial contraindications), and 17% (n=49) underwent LT during follow-up. Patients with frailty as measured by low GS at LT evaluation had significantly longer transplant LOS (median: 14 vs. 9 d, p=0.03) and higher direct costs of the LT hospitalization (median:$126,016 vs. $91,776, p=0.03) compared to those with normal GS. Patients who met all 3 frailty criteria (24% vs. 6%, p=0.08) and those who reported that 'everything was an effort (20% vs. 0%, p<0.001) were more likely have 30-day post-LT readmissions compared to those who did not. Patients who met all 3 and any one of the frailty criteria were more than twice as likely to be discharged to rehab post-LT, but differences did not reach statistical significance.

Conclusions: Abbreviated instruments to predict post-transplant healthcare utilization can be employed in clinical practice. Future studies should investigate how these measures correlate with waitlist health-care utilization, need for rehabilitation, and long-term outcomes.

CITATION INFORMATION: Serper M, Dwinnells K, Bittermann T, Olthoff K. A Brief Frailty Assessment and Outcomes Among Candidates for Liver Transplantation. Am J Transplant. 2017;17 (suppl 3).

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