Date: Sunday, June 12, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
To define frailty in the liver transplant (OLT) population to optimize care and assist in predicting post OLT outcomes.
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.
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).
|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|
|YES||163 (86%)||206 (62%)|
|NO||27 (14%)||127 (38%)|
|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%)|
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 24, 2020.
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