Frailty: What is it and how can it Affect Patients with Cirrhosis?

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Apr 25, 2017 | Kymberly Watt | @kymberlywatt | Comments (5)

Rahima A. Bhanji, M.D. was a special contributor to this blog post. Dr. Bhanji is a gastroenterology research fellow at Mayo Clinic in Rochester, Minnesota. Her interests include frailty, sarcopenia, end-stage liver disease needing liver transplantation and post-transplant care.

For someone needing a liver transplant, waiting can take a toll on strength and physical function. The progression of liver disease contributes to patients being less active. In addition, patients with progression of disease may have no appetite which may lead to poor nutrition. These changes can make you frail. If you become frail, can that physical weakness determine how well you do after liver transplant?

That is the question doctors at the Harvard Medical School were trying to answer when they conducted a study to determine how frailty affected outcomes for people with liver failure, a condition in which scar tissue builds up on the liver and causes the liver to not function properly. Because this damage to the liver can’t be fixed, people with liver failure usually require a transplant.

Let’s take a look at the study, the findings, and what this means for you.

About the study

This study, by Elliot B. Tapper and colleagues from Harvard Medical School was published in Hepatology in May 2015. It evaluates how frail a patient is and whether it impacts how they do after transplant. In this study, frailty was measured by using assessment tools that looked at the ability to complete activities of daily living, risk of developing bed sores, and likelihood of falling.

This research focused on 734 patients who were in the hospital with liver failure between 2010 and 2013. Researchers looked at how frail a patient was as a predictor of how well they did in terms of survival, readmission to hospital, and needing rehabilitation or physical therapy after the hospital stay.

The findings

Researchers found that frail patients were more likely to have complications and a longer hospital stay. They were two times more likely to die in the next three months and nearly four times more likely to need physical therapy after the hospital stay. 

Why it matters

It appears that simple bedside assessments of a patient’s strength and physical function can help predict complications for people with liver failure.

This knowledge matters because it alerts your care providers that you need an appropriate intervention. Studies have shown changes in diet and exercise can reverse frailty. Further research is being performed in patients with liver cirrhosis to assess the impact of diet and exercise on frailty.

If you are being treated for liver failure, talk to your care team about what you can do to maintain a level of strength that will ensure optimal long-term results, especially if transplant may be among your treatment options. Patients who remain active and have a good nutritional status have a better recovery after their transplant.

If you’ve had a liver transplant, what did you do to keep healthy before your surgery?

HELPFUL LINKS

• Learn about liver transplant at Mayo Clinic.
• Explore Mayo’s Transplant Center.
• Information and tools for a healthy lifestyle.
• Request an appointment.