Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Jun 18, 2025; 15(2): 98228
Published online Jun 18, 2025. doi: 10.5500/wjt.v15.i2.98228
Effect of frailty as measured by functional impairment on long-term outcomes in liver transplantation in the United States
Julius Balogh, Talha Mubashir, Yuan Li, Biai D Digbeu, Nikita Hegde, Fatemeh Movaghari Pour, Mohsen Rezapour, Hong-Yin Lai, Kelly West, Rabail A Chaudhry, George W Williams, Vahed Maroufy
Julius Balogh, Talha Mubashir, Department of CV Anesthesia, CHI St. Vincent Infirmary, Little Rock, AR 72205, United States
Yuan Li, Biai D Digbeu, Hong-Yin Lai, Vahed Maroufy, Department of Biostatistics and Data Science, The University of Texas Health Center at Houston School of Public Health, Houston, TX 77030, United States
Nikita Hegde, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA 98195, United States
Fatemeh Movaghari Pour, Department of Comprehensive Dentistry, UT Health San Antonio School of Dentistry, San Antonio, TX 78229, United States
Mohsen Rezapour, Vertex Pharmaceuticals, Boston, MA 02210, United States
Kelly West, George W Williams, Department of Anesthesiology, Critical Care and Pain Medicine, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX 77030, United States
Rabail A Chaudhry, Department of Anesthesiology and Pain Medicine, University of Arizona College of Medicine-Tucson, Tucson, AZ 85724, United States
Co-first authors: Julius Balogh and Talha Mubashir.
Author contributions: Balogh J and Mubashir T participated in research conceptualization, writing original draft, and project administration; Li Y and Digbeu BD participated in data curation, methodology development, formal analysis, and writing original draft; Hegde N, Pour FM, Rezapour M, Lai HY, West K, and Chaudhry RA participated in research conceptualization, writing original draft, and writing review and editing; Williams GW and Maroufy V participated in project supervision, project administration, methodology development, formal analysis, writing original draft, writing review and editing; all of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: The Institutional Review Board of the University of Texas Health Science Center at Houston does not require studies that use anonymized databases retrospectively to attain approval from this board.
Informed consent statement: For this study, data from the Scientific Registry of Transplant Recipients (SRTR) database were used. The SRTR database receives data directly collected by the Organ Procurement and Transplantation Network and is supplemented by data from the Centers for Medicare and Medicaid Services and the National Technical Information Service Death Master File. The SRTR makes data available after honoring all requirements regarding patients’ privacy in accordance with the Final Rule by the United States. Department of Health and Human Services. The Institutional Review Board of the University of Texas Health Science Center at Houston does not require studies that use anonymized databases retrospectively to attain approval from this board.
Conflict-of-interest statement: The authors declare that they have no conflict of interests.
Data sharing statement: The data is publicly available online.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vahed Maroufy, PhD, Assistant Professor, Department of Biostatistics and Data Science, The University of Texas Health Center at Houston School of Public Health, 1200 Pressler Street, Houston, TX 77030, United States. vahed.maroufy@uth.tmc.edu
Received: June 28, 2024
Revised: October 8, 2024
Accepted: December 9, 2024
Published online: June 18, 2025
Processing time: 237 Days and 20 Hours
Core Tip

Core Tip: In this study, we utilized an updated Karnofsky Performance Score, and intentionally converted the frailty assessment binary (frail vs non-frail) and enhancing reliability over more nuanced frailty assessments. Our study observed that frail recipients had significantly higher post-transplant mortality at 12 months, a critical period when transplant centers' monitoring traditionally wanes. Moreover, our study also showed a declining trend of the association between the model for end-stage liver disease score and post-transplant mortality, but an increasing trend between frailty and post-transplant mortality, from 1 month to 12 months post-transplant.