ATC Abstracts

American Transplant Congress abstracts

  • Home
  • Meetings Archive
    • 2022 American Transplant Congress
    • 2021 American Transplant Congress
    • 2020 American Transplant Congress
    • 2019 American Transplant Congress
    • 2018 American Transplant Congress
    • 2017 American Transplant Congress
    • 2016 American Transplant Congress
    • 2015 American Transplant Congress
    • 2013 American Transplant Congress
  • Keyword Index
  • Resources
    • 2021 Resources
    • 2016 Resources
      • 2016 Welcome Letter
      • ATC 2016 Program Planning Committees
      • ASTS Council 2015-2016
      • AST Board of Directors 2015-2016
    • 2015 Resources
      • 2015 Welcome Letter
      • ATC 2015 Program Planning Committees
      • ASTS Council 2014-2015
      • AST Board of Directors 2014-2015
      • 2015 Conference Schedule
  • Search

The Objective Liver Frailty Index Significantly Improves the Clinician “Eyeball Test” to Predict Mortality in Liver Transplant Candidates.

J. Lai, K. Covinsky, C. McCulloch, S. Feng.

UCSF, San Francisco

Meeting: 2017 American Transplant Congress

Abstract number: 445

Keywords: Age factors, Liver cirrhosis, Liver transplantation

Session Information

Session Name: Concurrent Session: Liver Waitlist Outcome and Risk Stratification

Session Type: Concurrent Session

Date: Tuesday, May 2, 2017

Session Time: 2:30pm-4:00pm

 Presentation Time: 3:42pm-3:54pm

Location: E271a

Background: Frailty is a critical determinant of waitlist outcomes. The most commonly-used test to assess frailty in liver transplant (LT) candidates is the “eyeball test”, which is limited by its subjectivity. We aimed to compare the objective Liver Frailty Index, which we developed using 3 performance-based tests (grip, chair stands, balance), with a subjective assessment by hepatologists.

Methods: Outpatient LT candidates w/o HCC underwent 2 frailty assessments:

1) Liver Frailty Index: (-0.3*gender-adjusted grip)+(-2.5*chair stands)+(-0.04*balance)+6, vs.

2) Eyeball test [0(robust)-5(frail)], assessed by a hepatologist (n=9; range 3-21y in practice).

Spearman's correlation and linear regression quantified associations b/n the Liver Frailty Index, the eyeball test, and clinical characteristics. Cox regression assessed associations with waitlist mortality (death/delisting for sickness). Discriminative ability for waitlist mortality was assessed with Concordance(C) statistics and compared with bootstrapping.

Results: Of 543 LT candidates: median age was 58y, MELDNa 18, and Child-Pugh (CPT) 8. Median(interquartile range) Liver Frailty Index was 3.8(3.4-4.3) and eyeball test score was 3(1-3).

Correlation b/n the Liver Frailty Index and the eyeball test was modest (rho=0.38; p<0.01) with high variability by provider (rho=0.26-0.70) independent of hepatologists' # of clinical practice years (rho= -0.12; p=0.8).

At a median followup of 11 months, 106 (20%) died/were delisted. Both the Liver Frailty Index (HR 3.0, 95% CI 2.3-3.8) and the eyeball test (HR 1.9, 95%CI 1.6-2.2) were associated with waitlist mortality [p<0.01].

C-statistics for the Liver Frailty Index were higher than, but not statistically significantly different from, the eyeball test (0.72 vs. 0.68; p=0.33). The addition of the Liver Frailty Index to the eyeball test significantly improved waitlist mortality prediction over the eyeball test alone (0.74 vs. 0.68; p<0.01).

Conclusion: The eyeball test can predict waitlist mortality in LT candidates, but is subjective and variable by hepatologist. The Liver Frailty Index was estimated to have slightly better predictive ability than the eyeball test, but the combination of the two assessments demonstrated even better mortality risk prediction than the eyeball test alone. Our data strongly support the incorporation of the objective Liver Frailty Index to anchor our eyeball test to enhance decision-making in LT.

CITATION INFORMATION: Lai J, Covinsky K, McCulloch C, Feng S. The Objective Liver Frailty Index Significantly Improves the Clinician “Eyeball Test” to Predict Mortality in Liver Transplant Candidates. Am J Transplant. 2017;17 (suppl 3).

  • Tweet
  • Email
  • Print

To cite this abstract in AMA style:

Lai J, Covinsky K, McCulloch C, Feng S. The Objective Liver Frailty Index Significantly Improves the Clinician “Eyeball Test” to Predict Mortality in Liver Transplant Candidates. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/the-objective-liver-frailty-index-significantly-improves-the-clinician-eyeball-test-to-predict-mortality-in-liver-transplant-candidates/. Accessed May 10, 2025.

« Back to 2017 American Transplant Congress

Visit Our Partner Sites

American Transplant Congress (ATC)

Visit the official site for the American Transplant Congress »

American Journal of Transplantation

The official publication for the American Society of Transplantation (AST) and the American Society of Transplant Surgeons (ASTS) »

American Society of Transplantation (AST)

An organization of more than 3000 professionals dedicated to advancing the field of transplantation. »

American Society of Transplant Surgeons (ASTS)

The society represents approximately 1,800 professionals dedicated to excellence in transplantation surgery. »

Copyright © 2013-2025 by American Society of Transplantation and the American Society of Transplant Surgeons. All rights reserved.

Privacy Policy | Terms of Use | Cookie Preferences