Physical frailty after liver transplantation
Frailty is prevalent in liver transplant candidates, but little is known of what happens to frailty after liver transplantation. We analyzed data for 214 adult liver transplant recipients who had ≥1 frailty assessment using the Liver Frailty Index (LFI) at 3‐ (n = 178), 6‐ (n = 139), or 12‐ (n = 107...
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| Veröffentlicht in: | American journal of transplantation 2018-08, Vol.18 (8), p.1986-1994 |
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| container_end_page | 1994 |
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| container_issue | 8 |
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| container_title | American journal of transplantation |
| container_volume | 18 |
| creator | Lai, Jennifer C. Segev, Dorry L. McCulloch, Charles E. Covinsky, Kenneth E. Dodge, Jennifer L. Feng, Sandy |
| description | Frailty is prevalent in liver transplant candidates, but little is known of what happens to frailty after liver transplantation. We analyzed data for 214 adult liver transplant recipients who had ≥1 frailty assessment using the Liver Frailty Index (LFI) at 3‐ (n = 178), 6‐ (n = 139), or 12‐ (n = 107) months posttransplant (higher values=more frail). “Frail” and “robust” were defined as LFI ≥4.5 and |
| doi_str_mv | 10.1111/ajt.14675 |
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Physical frailty only modestly improves after liver transplantation and is most strongly predicted by pretransplant physical frailty status, suggesting the need for structured interventions aimed at preventing pretransplant physical frailty to maximize physical health after liver transplantation. See Maddur and Levitsky's editorial on page 1841.</description><identifier>ISSN: 1600-6135</identifier><identifier>EISSN: 1600-6143</identifier><identifier>DOI: 10.1111/ajt.14675</identifier><identifier>PMID: 29380529</identifier><language>eng</language><publisher>United States: Elsevier Limited</publisher><subject>Aged ; clinical research/practice ; Cohort Studies ; comorbidities ; Comorbidity ; Data processing ; End Stage Liver Disease - surgery ; Female ; Follow-Up Studies ; Frailty ; Frailty - diagnosis ; Frailty - epidemiology ; geriatrics ; Humans ; Incidence ; Liver ; Liver transplantation ; Liver Transplantation - methods ; liver transplantation/hepatology ; Liver transplants ; Male ; Middle Aged ; nutrition ; patient characteristics ; Postoperative Complications ; Prognosis ; Quality of Life ; quality of life (QOL) ; rehabilitation ; Risk Factors ; Severity of Illness Index ; Transplants & implants ; United States - epidemiology</subject><ispartof>American journal of transplantation, 2018-08, Vol.18 (8), p.1986-1994</ispartof><rights>2018 The American Society of Transplantation and the American Society of Transplant Surgeons</rights><rights>2018 The American Society of Transplantation and the American Society of Transplant Surgeons.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5095-e00531d4eb0478e60c0c5eb8f177f3246ddd2f5a54ffc76549ae76716fe7d81e3</citedby><cites>FETCH-LOGICAL-c5095-e00531d4eb0478e60c0c5eb8f177f3246ddd2f5a54ffc76549ae76716fe7d81e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fajt.14675$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fajt.14675$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29380529$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lai, Jennifer C.</creatorcontrib><creatorcontrib>Segev, Dorry L.</creatorcontrib><creatorcontrib>McCulloch, Charles E.</creatorcontrib><creatorcontrib>Covinsky, Kenneth E.</creatorcontrib><creatorcontrib>Dodge, Jennifer L.</creatorcontrib><creatorcontrib>Feng, Sandy</creatorcontrib><title>Physical frailty after liver transplantation</title><title>American journal of transplantation</title><addtitle>Am J Transplant</addtitle><description>Frailty is prevalent in liver transplant candidates, but little is known of what happens to frailty after liver transplantation. We analyzed data for 214 adult liver transplant recipients who had ≥1 frailty assessment using the Liver Frailty Index (LFI) at 3‐ (n = 178), 6‐ (n = 139), or 12‐ (n = 107) months posttransplant (higher values=more frail). “Frail” and “robust” were defined as LFI ≥4.5 and <3.2. Median pre–liver transplant LFI was 3.7, and was worse at 3 months (3.9; P = .02), similar at 6 months (3.7; P = .07), and improved at 12 months (3.4; P < .001). The percentage who were robust pre‐ and 3‐, 6‐, and 12‐months posttransplant were 25%, 14%, 28%, and 37%; the percentage frail were 21%, 21%, 10%, and 7%. In univariable analysis, each 0.1 pretransplant LFI point more frail was associated with a decreased odds of being robust at 3‐ (odds ratio [OR] 0.75), 6‐ (OR 0.77), and 12‐months (OR 0.90) posttransplant (P ≤ .001), which did not change substantially with multivariable adjustment. In conclusion, frailty worsens 3 months posttransplant and improves modestly by 12 months, but fewer than 2 of 5 patients achieve robustness. Pretransplant LFI was a potent predictor of posttransplant robustness. Aggressive interventions aimed at preventing frailty pretransplant are urgently needed to maximize physical health after liver transplantation.
Physical frailty only modestly improves after liver transplantation and is most strongly predicted by pretransplant physical frailty status, suggesting the need for structured interventions aimed at preventing pretransplant physical frailty to maximize physical health after liver transplantation. See Maddur and Levitsky's editorial on page 1841.</description><subject>Aged</subject><subject>clinical research/practice</subject><subject>Cohort Studies</subject><subject>comorbidities</subject><subject>Comorbidity</subject><subject>Data processing</subject><subject>End Stage Liver Disease - surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Frailty</subject><subject>Frailty - diagnosis</subject><subject>Frailty - epidemiology</subject><subject>geriatrics</subject><subject>Humans</subject><subject>Incidence</subject><subject>Liver</subject><subject>Liver transplantation</subject><subject>Liver Transplantation - methods</subject><subject>liver transplantation/hepatology</subject><subject>Liver transplants</subject><subject>Male</subject><subject>Middle Aged</subject><subject>nutrition</subject><subject>patient characteristics</subject><subject>Postoperative Complications</subject><subject>Prognosis</subject><subject>Quality of Life</subject><subject>quality of life (QOL)</subject><subject>rehabilitation</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Transplants & implants</subject><subject>United States - epidemiology</subject><issn>1600-6135</issn><issn>1600-6143</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1LAzEQhoMotlYP_gEpeFGw7WQ3H7sXoRQ_KeihnkO6m9iUdLcmu5X990a3FhWcQ2YgDy_vzIvQKYYhDjWSy2qICeN0D3UxAxgwTOL93RzTDjryfgmAeZREh6gTpXECNEq76Op50XiTSdvXThpbNX2pK-X61mzCWzlZ-LWVRSUrUxbH6EBL69XJtvfQy-3NbHI_mD7dPUzG00FGIaUDBUBjnBM1B8ITxSCDjKp5ojHnOo4Iy_M80lRSonXGGSWpVJxxzLTieYJV3EPXre66nq9UnqkiGLFi7cxKukaU0ojfP4VZiNdyIxgwRggLAhdbAVe-1cpXYmV8pmzYRJW1FzhNY8CAwx166PwPuixrV4T1RAQ8YRGwmATqsqUyV3rvlN6ZwSA-MxAhA_GVQWDPfrrfkd9HD8CoBd6NVc3_SmL8OGslPwB4U5BN</recordid><startdate>201808</startdate><enddate>201808</enddate><creator>Lai, Jennifer C.</creator><creator>Segev, Dorry L.</creator><creator>McCulloch, Charles E.</creator><creator>Covinsky, Kenneth E.</creator><creator>Dodge, Jennifer L.</creator><creator>Feng, Sandy</creator><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201808</creationdate><title>Physical frailty after liver transplantation</title><author>Lai, Jennifer C. ; Segev, Dorry L. ; McCulloch, Charles E. ; Covinsky, Kenneth E. ; Dodge, Jennifer L. ; Feng, Sandy</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5095-e00531d4eb0478e60c0c5eb8f177f3246ddd2f5a54ffc76549ae76716fe7d81e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aged</topic><topic>clinical research/practice</topic><topic>Cohort Studies</topic><topic>comorbidities</topic><topic>Comorbidity</topic><topic>Data processing</topic><topic>End Stage Liver Disease - surgery</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Frailty</topic><topic>Frailty - diagnosis</topic><topic>Frailty - epidemiology</topic><topic>geriatrics</topic><topic>Humans</topic><topic>Incidence</topic><topic>Liver</topic><topic>Liver transplantation</topic><topic>Liver Transplantation - methods</topic><topic>liver transplantation/hepatology</topic><topic>Liver transplants</topic><topic>Male</topic><topic>Middle Aged</topic><topic>nutrition</topic><topic>patient characteristics</topic><topic>Postoperative Complications</topic><topic>Prognosis</topic><topic>Quality of Life</topic><topic>quality of life (QOL)</topic><topic>rehabilitation</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Transplants & implants</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lai, Jennifer C.</creatorcontrib><creatorcontrib>Segev, Dorry L.</creatorcontrib><creatorcontrib>McCulloch, Charles E.</creatorcontrib><creatorcontrib>Covinsky, Kenneth E.</creatorcontrib><creatorcontrib>Dodge, Jennifer L.</creatorcontrib><creatorcontrib>Feng, Sandy</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lai, Jennifer C.</au><au>Segev, Dorry L.</au><au>McCulloch, Charles E.</au><au>Covinsky, Kenneth E.</au><au>Dodge, Jennifer L.</au><au>Feng, Sandy</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Physical frailty after liver transplantation</atitle><jtitle>American journal of transplantation</jtitle><addtitle>Am J Transplant</addtitle><date>2018-08</date><risdate>2018</risdate><volume>18</volume><issue>8</issue><spage>1986</spage><epage>1994</epage><pages>1986-1994</pages><issn>1600-6135</issn><eissn>1600-6143</eissn><abstract>Frailty is prevalent in liver transplant candidates, but little is known of what happens to frailty after liver transplantation. We analyzed data for 214 adult liver transplant recipients who had ≥1 frailty assessment using the Liver Frailty Index (LFI) at 3‐ (n = 178), 6‐ (n = 139), or 12‐ (n = 107) months posttransplant (higher values=more frail). “Frail” and “robust” were defined as LFI ≥4.5 and <3.2. Median pre–liver transplant LFI was 3.7, and was worse at 3 months (3.9; P = .02), similar at 6 months (3.7; P = .07), and improved at 12 months (3.4; P < .001). The percentage who were robust pre‐ and 3‐, 6‐, and 12‐months posttransplant were 25%, 14%, 28%, and 37%; the percentage frail were 21%, 21%, 10%, and 7%. In univariable analysis, each 0.1 pretransplant LFI point more frail was associated with a decreased odds of being robust at 3‐ (odds ratio [OR] 0.75), 6‐ (OR 0.77), and 12‐months (OR 0.90) posttransplant (P ≤ .001), which did not change substantially with multivariable adjustment. In conclusion, frailty worsens 3 months posttransplant and improves modestly by 12 months, but fewer than 2 of 5 patients achieve robustness. Pretransplant LFI was a potent predictor of posttransplant robustness. Aggressive interventions aimed at preventing frailty pretransplant are urgently needed to maximize physical health after liver transplantation.
Physical frailty only modestly improves after liver transplantation and is most strongly predicted by pretransplant physical frailty status, suggesting the need for structured interventions aimed at preventing pretransplant physical frailty to maximize physical health after liver transplantation. See Maddur and Levitsky's editorial on page 1841.</abstract><cop>United States</cop><pub>Elsevier Limited</pub><pmid>29380529</pmid><doi>10.1111/ajt.14675</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged clinical research/practice Cohort Studies comorbidities Comorbidity Data processing End Stage Liver Disease - surgery Female Follow-Up Studies Frailty Frailty - diagnosis Frailty - epidemiology geriatrics Humans Incidence Liver Liver transplantation Liver Transplantation - methods liver transplantation/hepatology Liver transplants Male Middle Aged nutrition patient characteristics Postoperative Complications Prognosis Quality of Life quality of life (QOL) rehabilitation Risk Factors Severity of Illness Index Transplants & implants United States - epidemiology |
| title | Physical frailty after liver transplantation |
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