Frailty as a determinant of liver transplant outcomes: A call for integrative strategies

Table 1 Key findings of recent studies on frailty in liver transplant

Ref.	Study design	Age (years)	Male (%)	Frailty evaluation tool	Sample (frail/non-frail)	Key findings
Lai et al[1]	PCS	58	59%	LFI	536 (142/394)	Developed the LFI. A 0.1-unit increase in LFI was associated with a 12% increased hazard of mortality
Tapper et al[14]	PCS	54.5	60%	FFI	685 (279/406)	Patients with hepatic encephalopathy had a 25-fold higher hazard of mortality compared to others
Bhanji et al[15]	PCS	50.1	48.6%	CFS	105 (51/54)	Sarcopenia is more common in alcoholic disease and frailty in nonalcoholic steatohepatitis
DeMaria et al[16]	PCS	60	55%	FFS	50 (15/35)	Standardized frailty measures predicted hospital stays after liver transplantation
Bittermann et al[17]	PCS	54.1	56%	FFI	350 (120/230)	Low health literacy was associated with increased frailty and a 40% lower likelihood of liver transplantation
Kok et al[18]	PCS	56.4	40%	FFC	409 (146/263)	A 10-point reduction in quality of life score increased hospitalization by 20%
Kremer et al[19]	PCS	56.7	48%	CFS	299 (63/236)	Patients with a frailty score (Clinical Frailty Scale) ≥ 5 had a 25-fold higher mortality risk
Raveh et al[20]	RCS	54	52%	FSI	143 (76/67)	Developed a Comprehensive Frailty Severity Index, which predicts early outcomes after liver transplantation
Aby et al[21]	PCS	61	57%	LFI	233 (43/190)	Frailty in cirrhotic patients did not significantly impact caregiver burden, suggesting other factors may play a more prominent role
Deng et al[22]	PCS	57	58%	LFI	75 (11/64)	Frailty was associated with higher symptom burdens in cirrhotic patients, like fatigue, pain, and depression
Johnston et al[23]	PCS	53	57%	LFI	517 (125/392)	Dietetic assessments of frailty and sarcopenia in liver transplant candidates were highly reliable and feasible
Klein et al[24]	PCS	59.1	43%	LFI	114 (29/85)	Frailty was a significant predictor of survival after liver transplantation, especially in patients with MELD ≤ 15
Lin et al[25]	PCS	64	52.4%	LFI	881 (349–1277)	Prehabilitation-driven improvements in frailty metrics predicted reduced mortality in advanced liver disease patients
Skladany et al[26]	RCS	58	64%	FFI	385 (184/201)	Compared frailty in nonalcoholic fatty liver cirrhosis to alcoholic cirrhosis. Frailty was more prevalent in nonalcoholic cases and associated with worse survival
Soto et al[27]	PCS	64	56%	FFP	126 (84/42)	Frailty and reduced gait speed were independently related to long-term mortality in cirrhotic patients
Choi et al[28]	PCS	69.2	54%	mFI-5	155 (22/133)	Validated the Modified Charlson Comorbidity Index as a survival prediction tool for older liver transplant recipients
Williams et al[29]	RCS	54	57%	LFI	307 (47/260)	Both the Duke Activity Status Index and Liver Frailty Index effectively predicted mortality in ambulatory patients with advanced chronic liver disease

CFS: Clinical frailty scale; FFC: Fried frailty criteria; FFI: Fried frailty index; FFP: Fried frailty phenotype; FFS: Fried frailty score; FSI: Frailty severity index; LFI: Liver frailty index; mFI: Modified frailty index; NA: Not available; PCS: Prospective cohort study; RCS: Retrospective cohort study; CFS: CSHA Clinical frailty scale; MELD: Model for end-stage liver disease.