The Liver Frailty Index improves mortality risk prediction for GEMA-Na

Area of Science:

• Hepatology
• Transplantation Medicine
• Geriatrics

Background:

• Gender disparities exist in liver allocation, partly due to differences in muscle mass.
• Frailty, assessed by the Liver Frailty Index (LFI), predicts waitlist mortality (WLM) in cirrhosis patients.
• The Gender-Equity Model for Liver Allocation (GEMA-Na) aims to reduce gender bias in organ allocation.

Purpose of the Study:

• To determine if the Liver Frailty Index (LFI) improves waitlist mortality risk prediction beyond the GEMA-Na model.
• To assess the added prognostic value of frailty in liver transplant candidates.
• To evaluate model performance specifically in women, who are disproportionately affected by disparities.

Main Methods:

• Utilized data from the Functional Assessment in Liver Transplantation (FrAILT) study.
• Compared Cox proportional hazard models: GEMA-Na alone versus GEMA-Na + LFI.
• Assessed model performance using Uno's concordance statistic, continuous net reclassification index (NRI), and integrated discrimination improvement (IDI).

Main Results:

• Incorporating LFI into GEMA-Na significantly enhanced waitlist mortality prediction.
• Improved risk stratification was observed across multiple time points (3, 6, 12 months) and notably in women.
• Frailty emerged as an independent predictor of outcomes, beyond GEMA-Na's assessment of renal function.

Conclusions:

• The Liver Frailty Index (LFI) provides significant prognostic value for waitlist mortality in liver transplant candidates.
• Routine frailty assessment can improve risk stratification and potentially guide interventions like prehabilitation or expedited transplantation.
• Integrating frailty assessment into allocation models like GEMA-Na can further mitigate gender-based disparities in liver allocation.