Frailty as Tested by Gait Speed Is a Risk Factor for Liver Transplant Respiratory Complications

Am J Gastroenterol. 2020 Jun;115(6):859-866. doi: 10.14309/ajg.0000000000000609.

Abstract

Objectives: Frailty and sarcopenia are known risk factors for adverse liver transplant outcomes and mortality. We hypothesized that frailty or sarcopenia could identify the risk for common serious transplant-related adverse respiratory events.

Methods: For 107 patients (74 men, 33 women) transplanted over 1 year, we measured frailty with gait speed, chair stands, and Karnofsky Performance Scale (KPS) and sarcopenia with Skeletal Muscle Index on computed tomography at L3. We recorded the stress-tested cardiac double product as an index of cardiac work capacity. Outcomes included days of intubation, aspiration, clinical pneumonia, reintubation/tracheostomy, days to discharge, and survival. We modeled the outcomes using unadjusted regression and multivariable analyses controlled for (i) age, sex, and either Model for End-Stage Liver Disease-Na (MELDNa) or Child-Turcotte-Pugh scores, (ii) hepatocellular carcinoma status, and (iii) chronic obstructive pulmonary disease and smoking history. Subgroup analysis was performed for living donor liver transplant and deceased donor liver transplant recipients.

Results: Gait speed was negatively associated with aspiration and pulmonary infection, both in unadjusted and MELDNa-adjusted models (adjusted odds ratio for aspiration 0.10 [95% confidence interval [CI] 0.02-0.67] and adjusted odds ratio for pulmonary infection 0.12 [95% CI 0.02-0.75]). Unadjusted and MELDNa-adjusted models for gait speed (coefficient -1.47, 95% CI -2.39 to -0.56) and KPS (coefficient -3.17, 95% CI -5.02 to -1.32) were significantly associated with shorter intubation times. No test was associated with length of stay or need for either reintubation or tracheostomy.

Discussion: Slow gait speed, an index of general frailty, indicates significant risk for post-transplant respiratory complications. Intervention to arrest or reverse frailty merits exploration as a potentially modifiable risk factor for improving transplant respiratory outcomes.

MeSH terms

  • Aged
  • Airway Extubation
  • Carcinoma, Hepatocellular / etiology
  • Carcinoma, Hepatocellular / surgery
  • Female
  • Frailty / diagnosis
  • Frailty / epidemiology*
  • Frailty / physiopathology
  • Humans
  • Intubation, Intratracheal
  • Karnofsky Performance Status
  • Length of Stay
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / surgery*
  • Liver Neoplasms / etiology
  • Liver Neoplasms / surgery
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Physical Functional Performance
  • Pneumonia / epidemiology*
  • Postoperative Complications / epidemiology*
  • Respiration, Artificial / statistics & numerical data*
  • Respiratory Aspiration / epidemiology*
  • Retrospective Studies
  • Risk Factors
  • Sarcopenia / diagnostic imaging
  • Sarcopenia / epidemiology
  • Survival Rate
  • Tomography, X-Ray Computed
  • Tracheostomy
  • Walking Speed*