Relationship between frailty health literacy and clinical outcomes among liver transplant candidates at the University of Pennsylvania

Patients with end stage liver disease (ESLD) have high morbidity and mortality, which is attributed to a progressive decline in liver function and physical function. The adverse clinical outcomes in ESLD are mediated by liver-disease associated sarcopenia, or loss of muscle mass and frailty, defined as progressive loss of physiologic reserve and increased susceptibility to stressors (e.g. falls, infections). Patients with advanced ESLD on the liver transplant (LT) waitlist are particularly vulnerable. Although LT allocation is determined by the model for end stage liver disease (MELD), which predicts 90-day mortality and is calculated using biochemical parameters of liver and kidney function, it is well-established that frailty and sarcopenia add to the predictive validity of the MELD score, particularly at lower values of MELD. Frailty and sarcopenia are associated with increased pre-transplant mortality, becoming too sick for transplant, higher need for rehabilitation, and more 30-day hospital readmissions. Even more concerning, frailty studies have shown only partial reversal of sarcopenia (ranging from 6-28%) even for up to 3 years after LT. Despite the significant increased morbidity and mortality due to functional impairment, frailty, and sarcopenia, few interventions have been conducted in LT candidates. This is a retrospective study where we aim to evaluate the relationship between frailty, health literacy, and clinical outcomes among patients who were evaluated for transplant at the University of Pennsylvania.