P2368 - Liver Frailty Index and Outcomes After Liver Transplantation

David S. Braun, MD¹, Areeba Khwaja, MD², Hassan Allahrakha, DO³, Mingyang Cui, MSc⁴, Sohaib Raza, ⁴, Hellen Oduor, MBChB, MPH⁴, Parvez Mantry, MD^4
1Methodist Dallas Medical Center, Dallas, TX; ²University of Texas Health Science Center at Houston, Houston, TX; ³Methodist Dallas, Dallas, TX; ⁴Methodist Liver Institute, Dallas, TX

Introduction: Frailty assessment is a critical component of liver transplant (LT) evaluation. Frailty has been defined through various subjective and objective assessment tools, ranging from an “eyeball test” to a 6-minute walk test; however, no single test has emerged as a universal standard. The liver frailty index (LFI) integrates several instruments (i.e., grip strength, chair stands and balance testing) that have been utilized in other fields. Previous studies showed that higher LFI scores are associated with higher waitlist mortality and length of stay (LOS) after transplant. This study aimed to investigate whether LFI could predict clinical outcomes in patients after LT.

Methods: A retrospective database review was conducted of patients who underwent LT or simultaneous liver-kidney transplant (SLKT) between June 2017 and May 2022. Patients who underwent at least one LFI assessment preoperatively with a physical therapist were included. Patients < 18 years and those with a history of prior transplant or non-cirrhotic indications for LT were excluded. LFI was calculated on a validated categorical scale (<3.2=robust; 3.2-4.4=pre-frail; >4.4=frail). Clinical outcomes, including sepsis, urinary tract infection (UTI), pneumonia (PNA), skin and soft tissue infections (SSTI), hospital readmissions, total LOS, long-term facility admission and mortality were recorded one year after transplant. Outcomes were compared based on LFI using t-tests, Wilcoxon-Mann-Whitney tests, Chi square/Fisher’s exact tests or Pearson/Spearman correlations as applicable.

Results: A total of 243 patients were included in this study (female: 40.9%; median age: 60). 229 (94.2%) underwent LT and 14 (5.8%) underwent SLKT. When comparing robust, pre-frail and frail patients, there were significant differences in rates of UTI (0% vs. 3.44% vs. 10.7%, p= 0.030), long-term facility admission (0% vs. 6.21% vs. 21.4%, p=0.00037) and mortality (0% vs. 4.13% vs. 10.7%, p=0.035). There were no significant differences in rates of SSTI, PNA, sepsis, hospital readmission rates or LOS based on LFI rating.

Discussion: This study demonstrates that frailty increases the risk of UTI, long-term facility admission and mortality in the post-transplant period. Our findings promote the use of routine LFI testing in LT and SLKT evaluation. Rehabilitation must be considered in patients who are pre-frail and frail to improve outcomes and reduce infections, admissions to long-term facilities and mortality.


Disclosures:


David S. Braun, MD¹, Areeba Khwaja, MD², Hassan Allahrakha, DO³, Mingyang Cui, MSc⁴, Sohaib Raza, ⁴, Hellen Oduor, MBChB, MPH⁴, Parvez Mantry, MD⁴. P2368 - Liver Frailty Index and Outcomes After Liver Transplantation, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.