Multidimensional Frailty Assessment and Post-Transplant Outcomes in Liver Transplant Candidates

Condition(s) studied

Investigational drug(s) / intervention(s)

Comprehensive Observational Assessment in Liver Transplant Candidates: This study involves a comprehensive, multidimensional assessment of liver transplant candidates focusing on frailty, sarcopenia, malnutrition, and psychosocial status. Frailty will be measured using the Liver Frailty Index (LFI), 6-Minute Walk Test (6MWT), Karnofsky Performance Status (KPS), and Activities of Daily Living (ADL). Sarcopenia will be evaluated through handgrip strength, Appendicular Skeletal Muscle Mass (ASM)/Skeletal Muscle Index (SMI), and 4-meter gait speed. Malnutrition will be assessed using the Nutritional Risk Index (NRI) and phase angle derived from bioelectrical impedance analysis. Psychosocial status will be measured with the Hospital Anxiety and Depression Scale (HADS). Clinical parameters (MELD-Na, Child-Pugh, CKI-OKN) will be recorded. Post-transplant adverse outcomes including prolonged hospital and ICU stay, postoperative complications, early mortality, and duration of mechanical ventilation will be monitored up to 30 days after surgery.

Study summary

This study will evaluate frailty, nutrition, sarcopenia, and psychological health in people waiting for a liver transplant. The purpose is to understand how these factors affect outcomes before and after transplantation. By identifying patients at higher risk early, the study aims to support the development of better care programs in the future.

Participants will complete simple tests of physical strength, walking speed, and daily activity levels. Their nutrition and psychological well-being will also be assessed. The study will then look at how these results relate to medical scores used in liver disease and to outcomes after transplant, such as hospital stay, complications, or survival.

Adults aged 18-65 years who are on the liver transplant waiting list and can understand Turkish are eligible to join.

Eligibility

Primary outcome measure(s)

• Liver Frailty Index (LFI) — At hospital admission when liver transplantation is confirmed.
  Frailty will be assessed using the Liver Frailty Index (LFI), which is calculated from three standardized physical performance tests: grip strength (kg, average of three trials), chair stands (seconds to complete five repetitions), and balance test (seconds, up to 10 seconds in three positions). LFI score will be calculated according to the standard LFI formula. Frailty severity will be categorized as: ≥4.5: Severe frailty 3.2-4.4: Moderate frailty \<3.2: Not frail Unit of Measure: LFI score (continuous) Direction: Higher scores indicate greater frailty (worse outcome).
• 6-Minute Walk Test (6MWT) Distance — At hospital admission when liver transplantation is confirmed.
  The 6-minute walk test (6MWT) will be conducted according to European Respiratory Society and American Thoracic Society guidelines along a 30-meter corridor. Participants will be instructed to walk as far as possible in six minutes. Distance walked will be recorded in meters and rounded to the nearest meter. Oxygen saturation, heart rate, blood pressure, and fatigue (Modified Borg Scale) will be recorded before and after the test, with continuous SpO₂ and heart rate monitoring during the walk. Frailty classification will be based on the following thresholds: \<250 m (severe frailty), 250-350 m (moderate frailty), \>350 m (not frail). Unit of Measure: Meters (continuous) Direction: Higher walking distance indicates lower frailty (better outcome).
• Karnofsky Performance Status (KPS) — At hospital admission when liver transplantation is confirmed.
  The Karnofsky Performance Status (KPS) is a subjective measure of frailty, originally developed for oncology and subsequently applied in cirrhosis. The scale ranges from 0% (death) to 100% (normal; no complaints; no evidence of disease), scored in 10-point increments. Applicable to both hospitalized and ambulatory patients. Frailty classification will be based on the following thresholds: 0-40% = Severe frailty 50-70% = Moderate frailty ≥80% = Not frail Unit of Measure: Percentage (%) Direction: Higher KPS score indicates lower frailty (better outcome).
• Activities of Daily Living (ADL) — At hospital admission when liver transplantation is confirmed.
  The Activities of Daily Living (ADL) scale is a subjective measure of frailty, developed to assess functional status in aging populations. It evaluates six functions: bathing, dressing, toileting, continence, transferring, and feeding. The scale is self-reported and scored from 0 (dependent) to 6 (independent). Frailty classification will be based on the following thresholds: ≥2 difficulties (severe frailty), 1 difficulty (moderate frailty), and 0 difficulties (not frail). Unit of Measure: Score (0-6) Direction: Higher scores indicate lower frailty (better outcome).

Trial sites (1)

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