Frailty in liver transplantation: A comprehensive review

Frailty, a global impairment of multiple organ systems resulting in increased vulnerability to health stressors, is common in end-stage liver disease, multifactorial in etiology, and impacts overall mortality as well as outcomes in liver transplantation. This is a review of the currently available data, a synopsis of expert consensus, and a framework for transplant centers to approach frailty. We suggest that centers use a multidisciplinary team of healthcare providers and approach frailty in a programmatic fashion to provide effective patient care and ensure optimal transplant outcomes. The utilization of standardized protocols to address both malnutrition and physical debility is ideal and can help ensure safety. A toolbox of resources has been made available by experts in the field to facilitate this approach. The incorporation of new technology tailored to overcome barriers is another resource under investigation.