Frailty 1 year after liver transplant is associated with long-term mortality: From the Functional Assessment in Liver Transplantation (FrAILT) Study

Melinda Wang; Matthew R Kappus; Amy M Shui; Andres Duarte-Rojo; Elizabeth C Verna; Robert Rahimi; Elizabeth A King; Meredith Pearson; Marwan Ghabril; Daniela P Ladner; Daniel Ganger; Jennifer C Lai

doi:10.1097/LVT.0000000000000910

Frailty 1 year after liver transplant is associated with long-term mortality: From the Functional Assessment in Liver Transplantation (FrAILT) Study

Liver Transpl. 2026 May 27. doi: 10.1097/LVT.0000000000000910. Online ahead of print.

Authors

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA.
² Division of Gastroenterology and Hepatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
³ Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.
⁴ Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University, Chicago, Illinois, USA.
⁵ Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, New York, USA.
⁶ Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas, USA.
⁷ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁸ University of Washington, Seattle, Washington, USA.
⁹ Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA.

PMID: 42200628
DOI: 10.1097/LVT.0000000000000910

Abstract

Frailty before liver transplantation (LT) is a critical determinant of outcomes after LT. While frailty often improves after LT, it persists-and even worsens-in some. The extent to which post-LT frailty impacts longer-term outcomes has not been characterized. Adults with cirrhosis who underwent LT between 2013 and 2023 from 9 centers with an ambulatory frailty assessment [by Liver Frailty Index (LFI)] 12 months (±6 mo) post-LT were included. Kaplan-Meier methods were used to estimate post-LT survival beyond 1 year (1y) post-LT. Associations between 1y post-LT frailty and subsequent mortality were assessed using Cox regression. Linear regression was used to explore the association between 1y post-LT frailty and health-related quality of life (HrQoL) using the 36-Item Short Form Survey. Among 1097 LT recipients, 144 (13%) patients were frail 1y post-LT. Those who were frail 1y post-LT were more often women (47% vs. 33%), had MASLD (40% vs. 19%), diabetes (44% vs. 30%), stroke (3.5% vs. 0.6%), and pre-LT frailty (37% vs. 16%) (all p ≤0.001). At 3, 5, and 7 years after the 1y post-LT assessment, mortality was higher among those who were frail versus not frail 1y post-LT (13% vs. 6%, 24% vs. 10%, and 32% vs. 16%). After multivariate adjustment, 1y post-LT frailty was associated with a 2.0 times increased risk of post-LT mortality (95% CI 1.2-3.4, p =0.01) and worse physical HrQoL (estimate -9.99, 95% CI -12.5 to -7.5, p <0.001). Patients who were frail 1y after LT experienced >2-fold increased risk of long-term mortality and poorer physical HrQoL. Patients who transitioned from not frail pre-LT to frail 1y post-LT had a 2.5-fold increased risk of post-LT mortality (95% CI 1.3-4.8, p =0.005) compared with patients who remained not frail. These findings suggest the 1y period after LT may be a critical window for evaluating whether targeted frailty mitigation strategies may improve long-term survival among LT recipients.

Keywords: LFI; frailty; liver transplant; long-term; mortality.

Abstract

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