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      Frailty predicts waitlist mortality in liver transplant candidates.

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          Abstract

          We aimed to determine whether frailty, a validated geriatric construct of increased vulnerability to physiologic stressors, predicts mortality in liver transplant candidates. Consecutive adult outpatients listed for liver transplant with laboratory Model for End-Stage Liver Disease (MELD) ≥ 12 at a single center (97% recruitment rate) underwent four frailty assessments: Fried Frailty, Short Physical Performance Battery (SPPB), Activities of Daily Living (ADL) and Instrumental ADL (IADL) scales. Competing risks models associated frailty with waitlist mortality (death/delisting for being too sick for liver transplant). Two hundred ninety-four listed liver transplant patients with MELD ≥ 12, median age 60 years and MELD 15 were followed for 12 months. By Fried Frailty score ≥3, 17% were frail; 11/51 (22%) of the frail versus 25/243 (10%) of the not frail died/were delisted (p = 0.03). Each 1-unit increase in the Fried Frailty score was associated with a 45% (95% confidence interval, 4-202) increased risk of waitlist mortality adjusted for MELD. Similarly, the adjusted risk of waitlist mortality associated with each 1-unit decrease (i.e. increasing frailty) in the Short Physical Performance Battery (hazard ratio 1.19, 95% confidence interval 1.07-1.32). Frailty is prevalent in liver transplant candidates. It strongly predicts waitlist mortality, even after adjustment for liver disease severity demonstrating the applicability and importance of the frailty construct in this population.

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          Author and article information

          Journal
          Am. J. Transplant.
          American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
          1600-6143
          1600-6135
          Aug 2014
          : 14
          : 8
          Affiliations
          [1 ] Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, CA.
          Article
          NIHMS582769
          10.1111/ajt.12762
          4107151
          24935609
          f2e67fbc-951b-4ee6-ab95-743944a4b885
          © Copyright 2014 The American Society of Transplantation and the American Society of Transplant Surgeons.
          History

          Age,disability,functional status,sarcopenia,surgery
          Age, disability, functional status, sarcopenia, surgery

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