Home-based Liver Frailty Intervention (lift) in Liver Transplant Candidates: A Pilot Study
1Northwestern University Transplant Research Collaborative, Chicago, IL, 2Department of Psychology, Wayne State University, Detroit, MI
Meeting: 2021 American Transplant Congress
Abstract number: 140
Keywords: Liver cirrhosis, Liver transplantation, Prognosis, Risk factors
Topic: Clinical Science » Liver » Liver: Cirrhosis - Portal Hypertension and Other Complications
Session Name: Hemodynamic Consequences of Portal Hypertension Including Kidney Issues
Session Type: Rapid Fire Oral Abstract
Date: Sunday, June 6, 2021
Session Time: 4:30pm-5:30pm
Presentation Time: 5:00pm-5:05pm
*Purpose: Frailty is highly prevalent in patients awaiting LT and is associated with increased waitlist and post-transplant mortality, hospitalizations and LOS. While reduction of frailty is known to improve outcomes, logistically simple and affordable interventions are lacking. In this ongoing pilot study, we tested the feasibility and effectiveness of an evidence-informed home PT intervention to decrease frailty in LT candidates.
*Methods: In a single-center prospective study, adult patients were enrolled starting in 10/2020. The “LIver FrailTy” (LIFT) intervention consisted of a baseline evaluation (LFI, 4-meter gait speed [4MGS]), individualized home exercise regimen (with dumbbells, exercise bands), monitoring (smart phone exercise tracking, remote LFI measurement) and check-ins (email reminders, weekly phone calls). Clinical details were extracted from the EHR. Primary outcomes reported are LFI change over time and exercise adherence.
*Results: 21 LT candidates were enrolled between 10/2020-12/2020 (expecting enrollment of 150 by 5/2021). Mean age was 54.3 (±10.4) yrs, 12 (57%) were female, 76% White, 10% Black, 10% Hispanic and mean BMI was 30. Cirrhosis etiologies were Biliary (29%), NASH (19%), ETOH (14%), HCV (14%), and Other (24%). The mean MELD was 14.9 (±6.1) and 48% had decompensated cirrhosis. Mean baseline LFI was 3.65 (±0.59) with 5 (26%) robust, 13 (69%) pre-frail and 1 (5%) frail. Baseline grip strength was 27.1 (±10.1) kg and 4MGS was 2.82 (±0.64) sec. Exercise adherence was 56%. The exercise regimen was adjusted 1x for 3 patients, 2x for 1 patient and 3x for another based on patient feedback. Since enrollment (mean time 37 days), no patients developed new decompensating events, received a LT or died. Of the 8 patients who had a repeat LFI measured at 1 month after enrollment, the mean change in LFI was -0.06. LFI improved in 7 (88%) patients and worsened in 1 patient, who was hospitalized 2x during the study period including an ICU stay.
*Conclusions: We demonstrate feasibility of a home-based liver frailty intervention. We aim to enroll 150 patients, follow them longitudinally by 5/2021 and present correlations with clinical outcomes (hospitalization, complications and mortality).
To cite this abstract in AMA style:Thuluvath AJ, Belfanti K, Morrissey S, Siddiqui O, Peipert J, Daud A, Levitsky J, Bogg T, Flores A, Ladner DP. Home-based Liver Frailty Intervention (lift) in Liver Transplant Candidates: A Pilot Study [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/home-based-liver-frailty-intervention-lift-in-liver-transplant-candidates-a-pilot-study/. Accessed June 3, 2023.
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