Frailty is a phenotype of decreased physiologic reserve in response to stressors. Fried frailty was developed in community dwelling older adults. Among LT waitlist patients, 31% are frail, and Fried frailty is associated with number of hospitalizations, total hospitalized days and waitlist mortality after accounting for MELD score. While frailty is common among LT candidates, the prevalence of frailty at the time of LT and association with post-LT outcomes is unclear.

METHODS: We identified 211 patients at LT evaluation at Johns Hopkins Hospital (2016-2017) who consented to enrollment in a prospective cohort, 133 were listed for LT, and 57 underwent LT. Fried frailty is measured prior to LT, and ≥3 components was considered frail. Demographics and length of stay were compared between frail and nonfrail patients with chi-square and Student's t-test.

RESULTS: Of the 133 candidates listed for LT, 35 (26%) were frail. 3 waitlist candidates died, and all were frail. Of the 57 LT recipients 16 (28.1%) were frail at the time of LT. Age, sex, race, and MELD did not differ between frail and nonfrail LT recipients. However, frail LT candidates had a longer length of stay (p=0.05); the median LOS was 15 days (IQR: 6-34) for frail recipients and 10 days for nonfrail recipients (IQR:6-12). There was one death in the cohort; the LT recipient was frail and died two days after LT.

CONCLUSIONS: 26% of LT waitlist candidates and 28% of LT recipients are frail. MELD score between frail and nonfrail LT recipients did not differ, supporting the evidence that frailty is distinct from liver failure. Frail LT recipients have a longer length of stay; risk of mortality and graft loss among frail LT recipients will need to be evaluated after additional follow-up. Measurement of frailty at time of LT evaluation can guide patient counseling and risk assessment.

CITATION INFORMATION: Haugen C., Ying H., Holscher C., Lai J., Garonzik-Wang J., McAdams-DeMarco M., Segev D. Frailty and Liver Transplantation Am J Transplant. 2017;17 (suppl 3).

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