Comprehensive Frailty Severity Index for End-Stage Liver Disease Predicts Early Outcomes After Liver Transplantation

Background Frailty is rampant in candidates of liver transplantation (LT); however, its impact on posttransplant survival is inconclusive. Most studies have used a single measure of frailty; however, a comprehensive frailty severity index (FSI) has not been developed. The objectives of this study were to (1) evaluate frailty utilizing several metrics, (2) develop an FSI for end-stage liver disease (ESLD), and (3) determine its predictive abilities for outcomes after LT. Methods Frailty metrics included (1) modified nutrition assessment of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition that includes height-adjusted third lumbar vertebra psoas mass index, (2) physical performance assessment combining Karnofsky Performance Status and pressure injury scale, and (3) Controlling Nutritional Status as a measure of severity of liver disease and inflammation. Results Moderate to severe frailty was reported in 52%-97% of recipients depending on the metric. A statistically significant threshold FSI value was identified for each adverse outcome studied. FSI >= 14 was associated with decreased survival (88% vs 97% for FSI < 14). Conclusions The proposed FSI for ESLD is predictive of poorer outcomes after LT.