Defining Frailty in Liver Transplant Recipients.
1Surgery, Cleveland Clinic, Cleveland, OH
2Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
Meeting: 2016 American Transplant Congress
Abstract number: B256
Keywords: Age factors, Liver transplantation, Outcome, Risk factors
Session Information
Session Name: Poster Session B: Liver: MELD, Allocation and Donor Issues (DCD/ECD)
Session Type: Poster Session
Date: Sunday, June 12, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
PURPOSE
To define frailty in the liver transplant (OLT) population to optimize care and assist in predicting post OLT outcomes.
METHODS
All adult primary OLT patients from 01/2010 to 08/2014 were retrospectively reviewed. Nineteen potential preoperative frailty characteristics were evaluated in the following domains: 1. Functional status (Karnofsky score, encephalopathy), 2. Nutritional status (BMI, albumin, hematocrit), 3. Comorbid conditions (heart disease, diabetes, renal disease, hypothyroid, depression, peripheral vascular disease, acute kidney injury, tobacco use, peptic ulcer disease), 4. Extrinsic frailty (support at home), 5. Objective measures of disease severity: PT, INR, Cr, Bilirubin. Frailty was defined as any patient with either an overall length of stay >20 days, in-hospital mortality, 6-month mortality post-transplant, or discharge to a facility.
RESULTS
Overall, 523 patients were included in the study, with a median follow up time of 29 months. Mean age was 56±10 years (range 19-77), and 69% were male (361/523). Main indications for OLT were hepatitis C (25.8%, n= 135) and alcoholic cirrhosis (24.3%, n=127). Based on our frailty criteria, 36% (190/523) of patients qualified as frail. Multivariate analysis demonstrated presence of encephalopathy (OR 2.12), history of depression (2.14), MELD (OR 1.03), diabetes mellitus (OR 1.7), and Karnofsky score (1.04) are all independent risk factors for frailty in the OLT population (p<0.05 for all). The model had a c-statistic of 0.798 (95% CI 0.761-0.836).
| VARIABLES | FRAILTY | FRAILTY | p-values | |
| YES (190, 36%) | NO (333, 64%) | |||
| Karnofsky Score | 40 (30,60) | 70 (50,80) | <0.0001 | |
| MELD Score | 25 (16,34) | 15 (10,19) | <0.0001 | |
| Encephalopathy | <0.0001 | |||
| YES | 163 (86%) | 206 (62%) | ||
| NO | 27 (14%) | 127 (38%) | ||
| Diabetes Mellitus | 0.0191 | |||
| YES | 70 (37#) | 90 (27%) | ||
| NO | 120 (63%) | 243 (73%) | ||
| History of Depression | 0.0055 | |||
| YES | 52 (27%) | 57 (17%) | ||
| NO | 138 (73%) | 276 (83%) |
CONCLUSIONS
Frailty is prevalent in the OLT population. It is well recognized but difficult to objectively quantify. This study described specific preoperative frailty markers that can improve risk stratification with the goal of improving OLT recipient selection and outcomes. Future studies such as this may assist in OLT recipient selection in our highest risk populations.
CITATION INFORMATION: Louwers L, Eid K, Plescia J, Presser N, Muntean J, Kattan M, Chagrin K, Miller C, Kelly D. Defining Frailty in Liver Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Louwers L, Eid K, Plescia J, Presser N, Muntean J, Kattan M, Chagrin K, Miller C, Kelly D. Defining Frailty in Liver Transplant Recipients. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/defining-frailty-in-liver-transplant-recipients/. Accessed November 22, 2024.« Back to 2016 American Transplant Congress