PHYSICAL FRAILTY prior to liver transplant has been associated with poor functional status and health-related quality of life 1 year post-surgery in patients with cirrhosis, a new study had found. Previous research had already determined that frailty is associated with mortality, but the association with poor health had not yet been investigated. Jennifer Lai, University of California, San Francisco, USA, stressed the importance of understanding modifiable factors that determine quality of life in post-transplant years.
Lai and team analysed data from the Functional Assessment in Liver Transplantation study, including 358 patients with cirrhosis who had undergone a liver transplant between October 2016 and February 2020. The patients were assessed 1 year after their transplant, using Short Form-36, to evaluate the association between frailty prior to transplant and global functional health post-transplant. This included mental component summary scores (MCS), a physical component summary (PCS), performance tests on frailty phenotype and short physical performance, and an Instrumental Activities of Daily Living Scale.
Results showed that 19% of patients had frailty prior to their transplant, and that patients with frailty had lower median PCS scores compared with patients without frailty 1 year post-transplant (42 versus 40). Median MCS scores were similar in both groups (57 versus 57, respectively). Furthermore, frailty was linked to a 5.3-lower unit score in PCS post-transplant, but not MCS. Frailty was also associated to a higher number of patients with difficulty in one or more instrumental activities of daily living (21% versus 10%), and a higher number of patients who were unemployed or received disability (39% versus 29%).
The researchers also analysed 210 patients who underwent Liver Frailty Index assessment, and determined that 13% had frailty 1 year after transplant. These patients also had worse median Fried Frailty Phenotype scores (1 [1–2] versus 1 [0–1]), lower adjusted PCS scores, and higher rates of functional impairment by a Short Physical Performance Battery of 9 or less (42% versus 20%).
The team concluded that more studies that investigate outcomes other than survival are necessary. Lai stated: “The study data lay the foundation for interventions and therapeutics that target frailty that are administered before and/or early post-transplant to improve the global functional health in liver transplant recipients.”