Comparing Functional Frailty and Radiographic Sarcopenia as Predictors of Outcomes After Liver Transplant

ABSTRACT Introduction Frailty and sarcopenia are associated with an increased risk of hospitalization and mortality in patients with end‐stage liver disease. The ability to identify frail patients at risk of adverse outcomes could help optimize liver transplant (LT) evaluations and pre‐transplant care. This study compared sarcopenia, via L3‐psoas muscle index (L3‐PMI), to frailty, via liver frailty index (LFI) and analyzed associated outcomes after liver transplantation (LT). Methods A retrospective review of consecutive LT‐recipients with cross‐sectional abdominal/pelvic imaging were reviewed over 5 years at a single transplant center. Results Four hundred and twenty‐six patients underwent transplant during this study interval; 31% of patients were sarcopenic. Two hundred eight patients underwent LFI evaluation: 25% were frail, 59% were prefrail, and 16% were robust. Sarcopenic patients had higher LFI scores indicating greater frailty ( p = 0.02). Both sarcopenia and LFI‐frailty were associated with significantly higher MELD‐Na scores. Length of post‐LT hospital stay was increased in sarcopenic (mean 14 vs. nonsarcopenic 11 days, p = 0.02) and LFI‐frail patients (mean 13 vs. 10 prefrail, 8 robust, p = 0.04). As a categorical variable, neither LFI‐frailty nor sarcopenia were significantly associated with reduced survival at 1‐year (robust 100%, prefrail 93.5%, frail 91.1%, p = 0.31) (nonsarcopenic 94.4%, sarcopenic 91.4%, p = 0.30). However, LFI score was significantly associated with mortality at 1‐year (OR 2.133, p = 0.047). Conclusions Radiographic sarcopenia is a suitable proxy for in‐person frailty assessment as both L3‐PMI and LFI capture frail patients’ pre‐LT. However, physical assessment with frailty better predicts 1‐year mortality post‐LT than the measurement of muscle mass.