FRAILTY ASSESSMENT IN LIVER TRANSPLANT CANDIDATES AND ITS IMPACT ON DECISION-MAKING – A LATIN AMERICAN SURVEY

Introduction and Objectives

Frailty in cirrhosis is associated with adverse outcomes both before and after liver transplantation (LT). Clinical guidelines recommend its diagnosis and management; however, no clear guidance exists regarding its applicability for transplant eligibility, deferral, prioritization, or futility.

To characterize current practices among physicians regarding frailty assessment in LT candidates, and to describe its usefulness in clinical decision-making.

Materials and Methods

Descriptive observational study. Data were collected via an online survey targeting physicians who evaluate cirrhotic patients as LT candidates in Latin America.

Results

A total of 92 responses were obtained, with 91.3% of participants being hepatologists or gastroenterologists. Country distribution was: Chile (23.1%), Argentina (22.0%), Peru (12.1%), Mexico (8.8%), Brazil (6.6%), Colombia (6.6%), and others (20.8%). Frailty is assessed by 93.5% of respondents, with the most commonly used methods being the Liver Frailty Index (45.4%), Karnofsky score (33.7%), 6-minute walk test (25.6%), and handgrip strength (25.6%). For 63.95% of participants, frailty assessment influences decisions to delay listing or exclude patients from LT. In 39.53% and 30.23%, it influences preoperative optimization and postoperative planning, respectively. Reported challenges include limited time and staffing (68.48%), lack of standardized tools (45.65%), and limited access to equipment (29.35%).

Conclusions

Most physicians are already assessing frailty using validated objective methods. Although standardized recommendations are lacking, frailty assessment influences decision-making in the context of LT.

Conflict of interest: None