Frailty and BMI in Liver Transplant Candidates: 9-Center Functional Assessment in Liver Transplantation Study

C. Haugen¹, M. McAdams-DeMarco¹, D. Segev¹, E. Verna², R. Rahimi³, M. Kappus⁴, M. Volk⁵, M. Dunn⁶, A. Duarte Rojo⁶, D. Granger⁷, J. O'Leary⁸, D. Ladner⁷, J. Lai⁹

¹JHU, Baltimore, MD, ²Columbia, NYC, NY, ³Baylor, Dallas, TX, ⁴Duke, Durham, NC, ⁵Loma Linda, Loma Linda, CA, ⁶Pitt, Pittsburgh, PA, ⁷Northwestern, Chicago, IL, ⁸DVA, Dallas, TX, ⁹UCSF, San Francisco, CA

Meeting: 2019 American Transplant Congress

Abstract number: 565

Keywords: Liver transplantation, Obesity

Session Information

Session Name: Concurrent Session: Liver: Recipient Selection

Session Type: Concurrent Session

Date: Tuesday, June 4, 2019

Session Time: 4:30pm-6:00pm

Presentation Time: 4:42pm-4:54pm

Location: Room 312

*Purpose: Obesity and frailty are associated with an increased risk of waitlist mortality (WLM) in liver transplant (LT) candidates. However, body mass index (BMI) may not identify candidates at high risk for waitlist mortality, given ascites and sarcopenia seen across all ranges of BMI. We investigated the relationship between frailty, BMI, and WLM.

*Methods: We studied adult LT candidates without HCC at 9 LT centers. The Liver Frailty Index (LFI; grip strength, chair stands, balance) was assessed at outpatient visit; frail was defined as LFI≥4.5. We estimated the prevalence of frailty in non-obese (BMI 18.5-29), class I obese (BMI 30-34), and class II and higher obese (BMI≥35) candidates. We estimated risk of WLM (death/delisting for sickness) using competing risks regression by frailty status, adjusted for age, sex, race, MELDNa, diagnosis, and ascites with an interaction with BMI.

*Results: Among 1108 LT candidates, 26% were frail; 25% (BMI 18.5-29), 26% (BMI 30-34), and 29% (BMI≥35) were frail (p=0.6). Frail candidates had a 1.9-fold increased risk of WLM (aSHR:1.85,95%CI:1.36-2.50,p<0.001). Non-obese/frail and class I obese/frail candidates had a higher risk of WLM compared to nonfrail counterparts (non-obese aSHR: 1.54,95%CI:1.02-2.33,p=0.04; class I aSHR:1.72,95%CI:0.99-2.99,p=0.05; p interaction=0.8). Yet, class II and higher obese/frail candidates had a 3.19-fold increased risk of WLM compared to nonfrail class II and higher obese/candidates (aSHR:3.19,95%CI:1.75-5.82,p<0.001; p interaction=0.047).

*Conclusions: In this 9-center study of 1108 LT candidates, the prevalence of frailty was similar across all BMI categories. While frailty was associated with a 2-fold increased risk of WLM, this association did not vary between obese and non-obese candidates. However, among those with BMI≥35, there was a significant interaction between frailty and BMI, with frail patients having a >3-fold increased risk of WLM compared to nonfrail. Our data suggest that frailty may help to identify individuals most vulnerable to death, particularly very obese individuals in whom one’s “eyeball” test may be an unreliable metric of underlying muscle wasting and malnutrition.

To cite this abstract in AMA style:

Haugen C, McAdams-DeMarco M, Segev D, Verna E, Rahimi R, Kappus M, Volk M, Dunn M, Rojo ADuarte, Granger D, O'Leary J, Ladner D, Lai J. Frailty and BMI in Liver Transplant Candidates: 9-Center Functional Assessment in Liver Transplantation Study [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/frailty-and-bmi-in-liver-transplant-candidates-9-center-functional-assessment-in-liver-transplantation-study/. Accessed May 18, 2025.

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