Clinical burden of physical frailty in patients evaluated for liver transplantation: A retrospective cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND Frailty has been associated with mortality among patients referred for liver transplantation (LT), yet the impact on other clinical outcomes is less well defined. AIM To investigate the effect of physical frailty, measured by the liver frailty index (LFI), on the likelihood of LT, pre- and early post-LT outcomes, in an Australian cohort. METHODS Data were collected on adults with cirrhosis referred for LT and had their baseline LFI assessment. Outcomes of interest included: Receiving a LT, pre-LT unplanned hospitalizations, LT surgical complications, intensive care unit (ICU) and hospital length of stay. Cox proportional hazards modelling determined associations between LFI and outcomes, adjusting for age, sex, hepatocellular carcinoma, and model for end-stage liver disease score. Competing risk analysis explored reasons for not being transplanted including waitlist mortality [sub-hazards ratio (HR)]. RESULTS Among 266 patients [median model for end-stage liver disease 16 (interquartile range 11-19)], the median LFI was 3.7 (3.3-4.1); 19% were robust, 68% pre-frail, and 14% frail. After adjustment, each 1-point increase in the LFI was associated with a 29% lower likelihood of receiving a LT [HR = 0.71, 95% confidence interval (CI): 0.54-0.94, P = 0.020]. Competing-risk analysis showed higher LFI increased waitlist mortality (sub-HR = 1.90, 95%CI: 1.33-2.70). Each 1-point rise also conferred a 69% higher risk of unplanned pre-LT hospitalization (HR = 1.69, 95%CI: 1.09-2.62, P = 0.020). Among transplanted patients, higher LFI predicted prolonged ICU stay (> 4 days; odds ratio = 3.24, 95%CI: 1.06-9.85). Frailty was not associated with surgical complications or hospital length of stay. CONCLUSION Physical frailty independently predicts reduced LT likelihood, higher waitlist mortality, greater pre-LT unplanned hospitalizations, and prolonged ICU stay. This study provides the first Australian validation, extending LFI evidence beyond United States cohorts.
Source: World Journal of Hepatology
Language: English
Topic: Frailty in Older Adults
Subfield: Geriatrics and Gerontology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7140312200