Physical frailty after liver transplantation

Frailty is prevalent in liver transplant candidates, but little is known of what happens to frailty after liver transplantation. We analyzed data for 214 adult liver transplant recipients who had 1 frailty assessment using the Liver Frailty Index (LFI) at 3- (n=178), 6- (n=139), or 12- (n=107) months posttransplant (higher values=more frail). Frail and robust were defined as LFI 4.5 and <3.2. Median pre-liver transplant LFI was 3.7, and was worse at 3 months (3.9; P=.02), similar at 6months (3.7; P=.07), and improved at 12months (3.4; P<.001). The percentage who were robust pre- and 3-, 6-, and 12-months posttransplant were 25%, 14%, 28%, and 37%; the percentage frail were 21%, 21%, 10%, and 7%. In univariable analysis, each 0.1 pretransplant LFI point more frail was associated with a decreased odds of being robust at 3- (odds ratio [OR] 0.75), 6- (OR 0.77), and 12-months (OR 0.90) posttransplant (P.001), which did not change substantially with multivariable adjustment. In conclusion, frailty worsens 3months posttransplant and improves modestly by 12months, but fewer than 2 of 5 patients achieve robustness. Pretransplant LFI was a potent predictor of posttransplant robustness. Aggressive interventions aimed at preventing frailty pretransplant are urgently needed to maximize physical health after liver transplantation. Physical frailty only modestly improves after liver transplantation and is most strongly predicted by pretransplant physical frailty status, suggesting the need for structured interventions aimed at preventing pretransplant physical frailty to maximize physical health after liver transplantation. See Maddur and Levitsky's editorial on page 1841.