Background & Aims: Offering LT to frail patients may reduce waitlist mortality but may increase post-LT mortality. LT survival benefit is the concept of balancing these risks. We sought to quantify net survival benefit with LT by liver frailty index (LFI). Approach & Results: We analyzed data in the multi-center Functional Assessment in LT (FrAILT) Study from 2012-2021. Pre-LT cohort included ambulatory patients with cirrhosis awaiting LT, without hepatocellular carcinoma; post-LT cohort included those who underwent LT. Primary outcomes were pre-LT and post-LT mortality. We computed 1-, 3-, and 5-year restricted mean survival times (RMST) from adjusted Cox models. Survival benefit was calculated as net gain in life-years with LT. Pre-LT cohort included 2628 patients: median MELDNa was 18 (IQR 14-22); 731 (28%) were frail; 440 (17%) died pre-LT. Post-LT cohort included 1335 patients: median MELDNa was 20 (IQR 14-24); 325 (24%) were frail; 103 (8%) died post-LT. Pre-LT RMST decreased substantially as LFI increased. Post-LT RMST also decreased as LFI increased but only modestly. There was no LFI threshold at which pre-LT and post-LT RMST intersected—patients had net survival benefit at all LFI values. Conclusion: Pre-LT and, to a lesser degree, post-LT mortality increased as LFI increased. Transplant offered a survival benefit at all LFI values, driven by a reduction in pre-LT mortality. No threshold of LFI was identified at which the risk of post-LT mortality exceeded pre-LT mortality. LT offers net survival benefit even in the presence of advanced frailty among those selected for LT.

中文翻译：

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肝移植可为各种虚弱程度提供生存益处：来自肝移植研究中的多中心功能评估


背景和目标：向体弱患者提供 LT 可能会降低候补死亡率，但可能会增加 LT 后死亡率。 LT生存效益是平衡这些风险的概念。我们试图通过肝衰弱指数 (LFI) 来量化 LT 的净生存获益。方法和结果：我们分析了 2012 年至 2021 年多中心 LT 功能评估 (FrAILT) 研究中的数据。 LT 前队列包括等待 LT 的肝硬化门诊患者，无肝细胞癌； LT 后队列包括接受 LT 的患者。主要结局是 LT 前和 LT 后死亡率。我们根据调整后的 Cox 模型计算了 1 年、3 年和 5 年限制平均生存时间 (RMST)。生存获益计算为 LT 生命年的净收益。 LT 前队列包括 2628 名患者：MELDNa 中位数为 18 (IQR 14-22)； 731 人（28%）身体虚弱； 440 人 (17%) 在 LT 前死亡。 LT 后队列包括 1335 名患者：中位 MELDNa 为 20 (IQR 14-24)； 325 人（24%）身体虚弱； 103 人 (8%) 在 LT 后死亡。随着 LFI 增加，LT 前 RMST 大幅下降。 LT 后 RMST 也随着 LFI 的增加而下降，但幅度不大。 LT 前和 LT 后 RMST 相交的 LFI 阈值不存在——患者在所有 LFI 值下都有净生存获益。结论：随着 LFI 的增加，LT 前死亡率和 LT 后死亡率在较小程度上增加。由于 LT 前死亡率的降低，移植在所有 LFI 值下都提供了生存获益。没有确定 LFI 阈值，在该阈值下 LT 后死亡率的风险超过 LT 前的死亡率。即使选择接受 LT 的患者已处于晚期虚弱状态，LT 也能提供净生存获益。