*Purpose: Frailty and sarcopenia are associated with increased risk of hospitalization and mortality in end stage liver disease patients. Frailty can be measured clinically using functional scales such as the Liver Frailty Index (LFI), whereas sarcopenia is measured by quantifying muscle mass on imaging. The purpose of this study is to examine the correlation between LFI and sarcopenia, and their relative efficacy in predicting clinical outcomes after liver transplant.

*Methods: Patients who underwent LFI testing, abdominal imaging, and liver transplant between 2018-2019 were included in this study. Grip strength, timed chair stands, balance testing, and sex were factored into LFI scores that were rated as frail, pre-frail, and robust. Sarcopenia was assessed by total psoas area at the L3 cross-section on CT or MR and divided by patient height squared. Sex-specific thresholds were used to categorize patients as sarcopenic or non-sarcopenic.

*Results: 81 patients were included in this preliminary analysis: 60% male, 77% white, median age at transplant 62, median days on waitlist 48. 69 (85%) of these patients had imaging done near LFI evaluation and were assessed for sarcopenia. 32% of patients were sarcopenic; LFI scores were not significantly different based on sarcopenia status (Fig 1). Frail patients had significantly higher MELD-Na scores than robust patients (21.82 vs. 14.80, p=.05); sarcopenic patients had significantly higher MELD-Na scores than non-sarcopenic patients (23.46 vs. 17.43, p<.001). Length of post-transplant hospital stay and number of readmissions within 1 year were not significantly different between frailty nor sarcopenia categories. Pre-frail and frail patients had lower survival 1 year post transplant compared to robust patients, whereas sarcopenia was not associated with reduced 1 year survival (Fig 2).

*Conclusions: LFI quantified frailty and psoas-derived sarcopenia are both associated with higher MELD-Na scores. LFI is a better predictor of mortality after transplant than sarcopenia. LFI and sarcopenia are poorly correlated, requiring further analysis to determine which risk screening tools should guide pre-transplant frailty interventions.

« Back to 2021 American Transplant Congress