Effect of frailty as measured by functional impairment on long-term outcomes in liver transplantation in the United States

doi:10.5500/wjt.v15.i2.98228

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 15, Issue 2

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (18)

All Articles published online

The chart showing PDF series, HTML series, Figures (1-2) series, Tables (1-4) series.

Item

Count

PDF

HTML

Figures (1-2)

Tables (1-4)

Sum=16

Jun 18, 2025 (publication date) through Feb 21, 2025

Times Cited of This Article

Times Cited (0)

Journal Information of This Article

Publication Name

World Journal of Transplantation

ISSN

2220-3230

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Transplant. Jun 18, 2025; 15(2): 98228
Published online Jun 18, 2025. doi: 10.5500/wjt.v15.i2.98228

Table 1 Recipients’ baseline characteristics stratified by frail group, n (%)

Frailty status, recipients’ characteristics	Total (n = 37427)	Frail group (n = 30943)	Non-frail group (n = 6484)	P value
Age groups				< 0.001^a
18-34 years	957 (2.6)	850 (2.7)	107 (1.7)
35-49 years	7092 (18.9)	6075 (19.6)	1017 (15.7)
50-64 years	23529 (62.9)	19248 (62.2)	4281 (66.0)
> 64 years	5849 (15.6)	4770 (15.4)	1079 (16.6)
Gender				< 0.001^a
Male	25696 (68.7)	20700 (66.9)	4996 (77.1)
Female	11731 (31.3)	10243 (33.1)	1488 (22.9)
Race				< 0.001^a
White	26542 (70.9)	21993 (71.1)	4549 (70.2)
Black or African American	3267 (8.7)	2611 (8.4)	656 (10.1)
Hispanic Latino	5720 (15.3)	4942 (16.0)	778 (12.0)
Others	1898 (5.1)	1397 (4.5)	501 (7.7)
Body mass index (kg/m²), mean (SD)	29.1 (6.0)	29.1 (6.1)	29.0 (5.5)	0.429
Primary diagnosis				< 0.001^a
Viral	14003 (37.4)	10629 (34.4)	3374 (52.0)
Alcohol-associated	10940 (29.2)	9624 (31.1)	1316 (20.3)
Non-alcoholic steatohepatitis	7132 (19.1)	6181 (20.0)	951 (14.7)
Other/mixed	5352 (14.3)	4509 (14.6)	843 (13.0)
Model for end-stage liver disease score, unit, mean (SD)	23.3 (10.0)	24.7 (9.8)	16.7 (7.6)	< 0.001^a
Ventilator				< 0.001^a
No	35831 (95.7)	29357 (94.9)	6474 (99.8)
Yes	1596 (4.3)	1586 (5.1)	10 (0.2)
Warm ischemic time, minute, mean (SD)	40.4 (20.1)	40.6 (20.6)	39.8 (18.4)	0.029^a
Death indicator after transplant				0.022^a
Death	7955 (21.3)	6508 (21.0)	1447 (22.3)
Non-death	29472 (78.7)	24435 (79.0)	5037 (77.7)
Functional status at transplant in Karnofsky Performance Score scale				-
Normal	6484 (17.3)	0 (0.0)	6484 (100.0)
Moderate	14957 (40.0)	14957 (48.3)	0 (0.0)
Severe	15986 (42.7)	15986 (51.7)	0 (0.0)

^aStatistically significant at a significance level of 0.05.

The body mass index (BMI) was summarized after removing 12 outliers (BMI > 100 kg/m²): (1) 11 in the frail group; and (2) 1 in the non-frail group. The variables ‘warm ischemic time’ contains more than 50% of missing values; its test statistics is summarized by excluding the missing values.

Table 2 Donor characteristics stratified by recipient frailty status, n (%)

Recipient status, donor characteristics	Total (n = 37427)	Frail (n = 30943)	Non-frail (n = 6484)	P value
Age group				< 0.001^a
18-34 years	12966 (34.6)	10955 (35.4)	2011 (31.0)
35-49 years	10829 (28.9)	8912 (28.8)	1917 (29.6)
50-64 years	10478 (28.0)	8580 (27.7)	1898 (29.3)
> 64 years	3154 (8.4)	2496 (8.1)	658 (10.1)
Gender				0.758
Male	22517 (60.2)	18605 (60.1)	3912 (60.3)
Female	14910 (39.8)	12338 (39.9)	2572 (39.7)
Race				< 0.001^a
White	24549 (65.6)	20265 (65.5)	4284 (66.1)
Black or African American	6703 (17.9)	5565 (18.0)	1138 (17.6)
Hispanic Latino	4878 (13.0)	4120 (13.3)	758 (11.7)
Others	1297 (3.5)	993 (3.2)	304 (4.7)
Body mass index (kg/m²), mean (SD)	28.1 (6.5)	28.1 (6.5)	28.0 (6.5)	0.378
ABO blood group				< 0.001^a
A group	14889 (39.8)	12313 (39.8)	2576 (39.7)
AB group	503 (1.3)	380 (1.2)	123 (1.9)
B group	4520 (12.1)	3545 (11.5)	975 (15.0)
O group	17515 (46.8)	14705 (47.5)	2810 (43.3)
Donation pathway				0.414
Donation after brain death	35319 (94.4)	29214 (94.4)	6105 (94.2)
Donation after circulatory death	2108 (5.6)	1729 (5.6)	379 (5.8)
Cause of death				< 0.001^a
Anoxia	11695 (31.2)	9900 (32.0)	1795 (27.7)
Cerebrovascular/stroke	13389 (35.8)	10802 (34.9)	2587 (39.9)
Head trauma	11366 (30.4)	9448 (30.5)	1918 (29.6)
Central nervous system tumor	166 (0.4)	126 (0.4)	40 (0.6)
Others	811 (2.2)	667 (2.2)	144 (2.2)
Cigarette use in last 6 months				< 0.001^a
No	29766 (79.5)	24762 (80.0)	5004 (77.2)
Yes	7661 (20.5)	6181 (20.0)	1480 (22.8)
History of cocaine				0.001^a
No	30223 (80.8)	24895 (80.5)	5328 (82.2)
Yes	7204 (19.2)	6048 (19.5)	1156 (17.8)
History of diabetes				0.174
No	32921 (88.0)	27250 (88.1)	5671 (87.5)
Yes	4506 (12.0)	3693 (11.9)	813 (12.5)
History of hypertension				< 0.001^a
No	23610 (63.1)	19677 (63.6)	3933 (60.7)
Yes	13817 (36.9)	11266 (36.4)	2551 (39.3)
High risk for organ donor				< 0.001^a
No	29843 (79.7)	24477 (79.1)	5366 (82.8)
Yes	7584 (20.3)	6466 (20.9)	1118 (17.2)
Warm ischemic time, minute, mean (SD)	3.8 (8.3)	3.5 (7.8)	5.9 (10.5)	< 0.001^a

^astatistically significant at a significance level of 0.05.

Table 3 Multi-variable analysis for mortality (mortality time are within 1 month, 6 months, 12 months)

Variables	1 month				6 months				12 months
Variables	OR	L	U	P value	OR	L	U	P value	OR	L	U	P value
Donation pathway (ref: Donation after brain death)
Donation after circulatory death	1.16	0.48	3.03	0.75	1.08	0.62	1.95	0.79	1.01	0.62	1.69	0.95
Donor's age group (ref: > 64 years)
18-34 years	-	-	-	-	0.66	0.15	4.58	0.61	0.37	0.12	1.47	0.12
35-49 years	-	-	-	-	0.61	0.14	4.24	0.55	0.44	0.14	1.71	0.19
50-64 years	-	-	-	-	1.41	0.34	9.71	0.67	0.88	0.28	3.43	0.84
Donor continued use cigarette in past 6 month (ref: No)
Yes	0.79	0.26	2.08	0.66	0.78	0.40	1.45	0.45	0.68	0.38	1.19	0.19
Donor's history of cocaine use (ref: No)
Yes	1.39	0.46	3.65	0.52	0.50	0.21	1.04	0.09	0.59	0.29	1.09	0.11
Donor gender (ref: Female)
Male	1.18	0.52	2.89	0.70	1.38	0.82	2.40	0.24	1.41	0.89	2.28	0.15
Donor BMI (kg/m²)	1.04	0.96	1.12	0.28	0.99	0.94	1.04	0.75	0.99	0.94	1.03	0.51
Donor's history of diabetes (ref: No)
Yes	2.56	0.59	9.13	0.17	1.78	0.68	4.23	0.21	1.59	0.67	3.50	0.26
Donor's history of hypertension (ref: No)
Yes	2.02	0.76	5.17	0.15	1.39	0.74	2.54	0.29	1.36	0.79	2.30	0.26
High risk for organ donor (ref: No)
Yes	0.93	0.24	2.80	0.91	0.86	0.36	1.83	0.71	1.19	0.60	2.21	0.60
Donor's race (ref: White)
Black or African American	0.36	0.05	1.40	0.20	0.84	0.33	1.84	0.68	0.66	0.28	1.37	0.30
Hispanic Latino	0.23	0.01	1.23	0.17	0.67	0.22	1.67	0.43	0.72	0.28	1.59	0.45
Others	0.63	0.03	3.71	0.68	1.95	0.53	5.64	0.26	1.30	0.36	3.63	0.65
Donor warm ischemic time	0.99	0.95	1.03	0.73	1.01	0.98	1.03	0.40	1.01	0.99	1.03	0.35
Recipient's age group (ref: > 64 years)
18-34 years	3.86	0.33	45.54	0.26	1.55	0.20	7.94	0.63	1.83	0.34	7.71	0.44
35-49 years	1.44	0.29	10.60	0.68	0.91	0.39	2.23	0.83	0.71	0.34	1.53	0.37
50-64 years	1.80	0.48	11.91	0.45	0.92	0.45	2.02	0.82	0.79	0.43	1.52	0.46
Recipient gender (ref: Female)
Male	1.27	0.53	3.28	0.61	1.84	1.04	3.39	0.04	1.76	1.07	2.98	0.03
Recipient race (ref: White)
Black or African American	3.36	1.12	9.14	0.02	1.62	0.73	3.32	0.21	1.32	0.64	2.54	0.43
Hispanic Latino	2.80	0.99	7.27	0.04	1.01	0.48	1.96	0.98	0.95	0.50	1.71	0.86
Others	-	-	-	-	1.11	0.25	3.46	0.88	1.03	0.29	2.87	0.96
Recipient primary diagnosis (ref: Alcohol-associated)
Non-alcoholic steatohepatitis	2.37	0.48	11.44	0.27	1.95	0.79	4.71	0.14	1.43	0.63	3.15	0.38
Other/mixed	6.06	1.86	24.03	^a	2.07	0.92	4.62	0.08	1.92	0.95	3.90	0.07
Viral	1.94	0.63	7.33	0.28	1.87	1.00	3.67	0.06	1.98	1.15	3.54	0.02
Model for end-stage liver disease score	1.06	1.02	1.12	0.01	1.05	1.02	1.08	0.00	1.04	1.02	1.07	^a
Recipient BMI (kg/m²)	1.02	0.96	1.09	0.50	1.00	0.96	1.05	0.95	1.02	0.98	1.05	0.41
Recipient warm ischemic time	1.00	0.98	1.02	0.81	0.99	0.98	1.00	0.21	0.99	0.98	1.00	0.32
Ventilator (ref: No)
Yes	3.93	0.83	15.26	0.06	3.91	1.28	11.13	0.01	4.73	1.71	12.71	^a
Frail status at transplant (non-frailty)
Frailty	1.04	0.40	2.99	0.94	1.60	0.86	3.12	0.15	1.89	1.09	3.41	0.03

^aThe P value is less than 0.001.

The models were done after excluding 12 patients with outliers in variable ‘recipients’ body mass index. BMI: Body mass index; L: The lower boundary of the 95%CI, i.e. 2.5% of CI; OR: Odds ratio; Ref: Reference group; U: The upper boundary of the 95%CI; -: The values are large due to the sample size and the P value is not significant, so does not show the exact value the table.

Table 4 Multi-variable analysis for frailty status at transplant

Variables	Odds ratio	*The lower boundary of the 95%CI, i.e., 2.5% of CI*	*The upper boundary of the 95%CI, i.e., 97.5% of CI*	P value	Coefficient	SE	Statistics values
Donation pathway (ref: Donation after brain death)
Donation after circulatory death	1.86	1.30	2.65	< 0.001^a	0.62	0.18	3.44
Donor's age group (ref: > 64 years)
18-34 years	1.19	0.48	2.99	0.70	0.18	0.46	0.38
35-49 years	1.53	0.62	3.79	0.36	0.42	0.46	0.92
50-64 years	1.05	0.42	2.63	0.92	0.05	0.47	0.10
Donor continued use cigarette in past 6 month (ref: No)
Yes	1.09	0.73	1.63	0.68	0.08	0.20	0.41
Donor's history of cocaine use (ref: No)
Yes	1.15	0.75	1.77	0.53	0.14	0.22	0.63
Donor gender (ref: Female)
Male	1.09	0.78	1.50	0.62	0.08	0.16	0.50
Donor BMI (kg/m²)	0.99	0.96	1.02	0.49	-0.01	0.01	-0.69
Donor's history of diabetes (ref: No)
Yes	0.78	0.42	1.47	0.43	-0.25	0.32	-0.78
Donor's history of hypertension (ref: No)
Yes	0.65	0.44	0.96	0.03^a	-0.43	0.20	-2.20
High risk for organ donor (ref: No)
Yes	1.11	0.69	1.81	0.68	0.10	0.25	0.42
Donor's race (ref: White)
Black or African American	1.19	0.72	2.01	0.51	0.17	0.26	0.66
Hispanic Latino	0.75	0.43	1.34	0.32	-0.29	0.29	-0.99
Others	0.53	0.23	1.29	0.15	-0.63	0.43	-1.44
Donor warm ischemic time (minutes)	1.00	0.99	1.02	0.85	0.00	0.01	0.19
Recipient's age group (ref: > 64 years)
18-34 years	0.65	0.16	2.90	0.55	-0.43	0.72	-0.60
35-49 years	0.83	0.48	1.44	0.51	-0.18	0.28	-0.65
50-64 years	1.12	0.69	1.79	0.63	0.11	0.24	0.48
Recipient gender (ref: Female)
Male	0.80	0.56	1.13	0.21	-0.23	0.18	-1.26
Recipient race (ref: White)
Black or African American	0.65	0.39	1.10	0.10	-0.42	0.26	-1.63
Hispanic Latino	1.62	1.00	2.71	0.06	0.48	0.25	1.90
Others	1.26	0.59	2.90	0.56	0.23	0.40	0.58
Recipient primary diagnosis (ref: Alcohol-associated)
Non-alcoholic steatohepatitis	0.95	0.53	1.70	0.85	-0.06	0.30	-0.19
Other/mixed	0.87	0.52	1.46	0.60	-0.14	0.26	-0.52
Viral	0.79	0.53	1.17	0.24	-0.24	0.20	-1.19
Model for end-stage liver disease score	1.10	1.08	1.13	< 0.001^a	0.10	0.01	8.79
Recipient BMI (kg/m²)	1.01	0.98	1.04	0.65	0.01	0.01	0.46
Recipient warm ischemic time (minutes)	0.989	0.983	0.996	0.002^a	-0.01	0.00	-3.08

^astatistically significant at a significance level of 0.05.

The models were done after excluding 12 patients with outliers in variable ‘recipients’ body mass index. BMI: Body mass index; Ref: Reference group.

Citation: Balogh J, Mubashir T, Li Y, Digbeu BD, Hegde N, Pour FM, Rezapour M, Lai HY, West K, Chaudhry RA, Williams GW, Maroufy V. Effect of frailty as measured by functional impairment on long-term outcomes in liver transplantation in the United States. World J Transplant 2025; 15(2): 98228
URL: https://www.wjgnet.com/2220-3230/full/v15/i2/98228.htm
DOI: https://dx.doi.org/10.5500/wjt.v15.i2.98228