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

Frailty and sarcopenia are associated with increased risk of hospitalization and mortality in patients with end-stage liver disease. Frailty can be measured clinically using functional scales such as the Liver Frailty Index (LFI), whereas sarcopenia is measured by quantifying muscle mass on imaging. The purpose of this research study is to examine the correlation between LFI and sarcopenia, and their relative efficacy in predicting clinical outcomes after liver transplant. This study will review patients who underwent LFI examination, abdominal imaging, and liver transplant between 2014-2019 at Northwestern Memorial Hospital. Grip strength, timed chair stands, balance testing, and sex are factored into LFI scores that are rated as frail, pre-frail, and robust. Sarcopenia will be assessed by total psoas area at the L3 cross-section on CT or MR imaging and divided by patient height squared. Sex-specific thresholds are used to categorized patients as sarcopenic or non-sarcopenic. Other highly-studied predictors of frailty- age, MELD-Na score, serum albumin- will be included in analysis. Outcomes assessed will include operative complications, hospital re-admissions, need for second liver transplant, and death. This project aims to identify the differences and value of using functional frailty metrics (LFI) compared to radiographic data (sarcopenia) compared to lab data (MELD-Na score). By identifying which frailty metrics are best able to pre/peri operatively identify patients at risk of poor outcomes after transplant we can target future clinical interventions, such as nutritional support and physical therapy, to patients that may benefit most.