Quality of Life in Liver Transplant Candidates: Frailty Is a Better Indicator Than Severity of Liver Disease

Background. In an effort to understand the diminished quality of life (QoL) exhibited by patients with end-stage liver disease (ESLD), we studied the association of frailty and severity of liver disease with quality of life in this patient population. Methods. In a prospective, single-center cohort study (N = 487), we assessed frailty and QoL in patients with ESLD referred for liver transplant. Frailty was measured on a scale from 0 to 5 by grip strength, gait speed, exhaustion, shrinkage, and physical activity, with scores of 3 or higher characterized as frail. Physical, mental, and combined overall quality of life scores ranging from 0 to 100 were assessed using Short Form 36. Pearson correlation and multiple linear regression were used to identify variables associated with QoL. Results. Quality of life was notably low in the study cohort (mean: physical, 42.9 +/- 24.1; mental, 58.3 +/- 23.2). In multivariate analysis adjusted for demographic and clinical characteristics, frailty was significantly negative associated with physical (slope, -22.55, 95% confidence interval, -26.39 to -18.71; P < 0.001) and mental QoL (slope, -17.59, 95% confidence interval, -21.47 to -13.71; P < 0.001). Model for ESLD (MELD) was not associated with QoL. Conclusion. In ESLD patient referred for liver transplant, diminished QoL appears to be significantly negatively associated with frailty and not with severity of liver disease as measured MELD. With further study, if frailty is shown to be a remediable condition, targeted programs may help decrease frailty and improve quality of life in ESLD patients.