Combination of Frailty and Sarcopenia Predicts Peri-operative Outcomes in Patients Undergoing Liver Transplantation:...

Sarcopenia and frailty contribute to adverse clinical outcomes in patients with cirrhosis awaiting and after liver transplantation (LT). However, the impact of sarcopenia/physical frailty on perioperative LT outcomes has not been reported. The effect of physical frailty and sarcopenia on hospitalization outcomes in patients undergoing liver transplantation was evaluated in a nationwide dataset.

Adult patients undergoing liver transplantation from 2016 to 2020 in the National Inpatient Sample database without/with frailty (defined by the hospital frailty risk score) and/or sarcopenia (defined by muscle-loss phenotype) were analyzed. Patients were stratified into those without sarcopenia or frailty (sarcopenia/frailty), with either sarcopenia/frailty, and those with both sarcopenia and frailty. Univariate and multivariate logistic/linear regression analyses were performed to compare in-hospital mortality, perioperative organ system complications, length of stay, and costs during the LT hospitalization in patients without/with frailty and/or sarcopenia. Adjustments were made for patient demographics, hospital characteristics, modified Charlson comorbidity index, etiology, and decompensation of liver disease.

Among the 34,405 LT recipients, there was a high prevalence of frailty alone (35%), sarcopenia alone (7.6%), or both sarcopenia/frailty (29.2%). Patients with both frailty and sarcopenia had higher in-hospital mortality (4.6%), periprocedural complications (79.4%), and non-routine discharge (71.4%) than patients with frailty, sarcopenia alone or neither sarcopenia nor frailty. Combined frailty and sarcopenia was associated with higher odds of in-hospital mortality, compared to patients with neither sarcopenia or frailty (aOR 4.06, p < 0.001).

Combined frailty and sarcopenia are associated with an increased risk of mortality in hospitalized patients undergoing LT. Increased awareness and interventions to improve these risk factors should be emphasized before LT.