ArticleAnnals of surgery2020
Multicenter Study of Age, Frailty, and Waitlist Mortality Among Liver Transplant Candidates.
Article in Annals of surgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
39 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Change in frailty status in the 12 months following solid organ transplantation: a systematic review and meta-analysis.Age and ageing · 2025Pooled it
- Malnutrition, Frailty, and Sarcopenia in Patients With Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases.Hepatology (Baltimore, Md.) · 2021Guideline
- Strength training intervention with creatine/whey protein supplementation vs placebo on frailty in older adults with cirrhosis (STRIVE): A Randomized Controlled Trial.Research square · 2026Article
- Prognostic Significance of Frailty in Liver Cirrhosis Patients: A Prospective Single-Center Study.Journal of clinical medicine · 2026Article
- Longitudinal association of frailty levels with knee osteoarthritis in middle-aged and elderly chinese: a longitudinal cohort study.Scientific reports · 2026Article
- Current management strategies for sarcopenia and frailty in cirrhosis: Missing link in transplant candidacy.World journal of hepatology · 2026Review
- Frailty in Hepatocellular Carcinoma: An Unsettled Clinical Challenge.Current oncology (Toronto, Ont.) · 2026Review
- Frailty and liver transplant eligibility beyond MELD scores: integrating functional status into candidate selection.BMC gastroenterology · 2025Article
- The impact of age and frailty on hospitalization and survival in older liver transplant recipients: a longitudinal cohort study.Frontiers in aging · 2025Article
- Explainable machine learning for prognostic modeling of waitlist mortality in cirrhotic liver transplantation.Computational and structural biotechnology journal · 2025Article
- Challenges in Liver Transplantation for Hepatocellular Carcinoma: A Review of Current Controversies.Cancers · 2024Review
- Comparing Functional Frailty and Radiographic Sarcopenia as Predictors of Outcomes After Liver Transplant.Clinical transplantation · 2024Article
- Evaluating the Correlation Between Anteroposterior Diameter, Body Surface Area, and Height for Liver Transplant Donors and Recipients.Transplantation direct · 2024Article
- Review
- Can the Multidimensional Prognostic Index (MPI) be a predictive instrument for mortality in older adult liver transplant candidates?European geriatric medicine · 2023Observational
- Liver transplantation in the patient with physical frailty.Journal of hepatology · 2023Review
- Cellular Senescence and Frailty in Transplantation.Current transplantation reports · 2023Article
- Frailty as a predictor of poor outcomes among patients awaiting liver transplant: a systematic review and meta-analysis.Gastroenterology and hepatology from bed to bench · 2023Review
- Frailty and solid-organ transplant candidates: a scoping review.BMC geriatrics · 2022Article
- Evaluation of liver transplant candidates with non-alcoholic steatohepatitis.Translational gastroenterology and hepatology · 2022Review
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
objectiveTo determine if the association of frailty and waitlist mortality varies by candidate age.
backgroundFrailty, a construct developed in geriatrics, is a state of decreased physiologic reserve, and is associated with mortality while awaiting liver transplantation (LT). However, older candidates have high comorbidity burden and less physiologic reserve, so the relationship between frailty and waitlist mortality may vary by candidate age.
methodsWe studied adults listed for LT at 2 transplant centers. The liver frailty index (grip strength, chair stands, balance) was measured at evaluation, with frailty defined as liver frailty index ≥ 4.5. We compared the prevalence of frailty in older (≥65 yr) and younger (18-64 yr) candidates. We studied the association between frailty, age, interaction between the 2, and waitlist mortality using competing risks regression adjusted for sex, BMI, and MELDNa.
resultsAmong 882 LT candidates, 16.6% were ≥ 65 years. Older candidates were more likely to be frail (33.3% vs 21.7%, P = 0.002). Older age [adjusted subhazard ratio (aSHR): 2.16, 95% CI: 1.51-3.09, P < 0.001] and frailty (aSHR: 1.92, 95% CI: 1.38-2.67, P < 0.001) were independently associated with higher risk of waitlist mortality. However, the association between waitlist mortality and frailty did not vary by candidate age (aSHR of frailty for younger patients: 1.90, 95% CI: 1.28-2.80, P = 0.001; aSHR of frailty for older patients: 1.98, 95% CI: 1.07-3.67, P = 0.03; P interaction = 0.9).
conclusionsOlder candidates experienced higher rates of frailty than younger candidates. However, regardless of age, frailty was associated with nearly 2-fold increased risk of waitlist mortality. Our data support the applicability of the frailty concept to the whole LT population and can guide the development of prehabilitation programs targeting frailty in LT patients of all ages.
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