Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of China Medical University, Shenyang 110001, China.
Department of Urinary Surgery, Northeast International Hospital, Shenyang, 110623, China.
Transplant Rev (Orlando). 2024 Dec;38(4):100884. doi: 10.1016/j.trre.2024.100884. Epub 2024 Oct 9.
Physical frailty increases susceptibility to stressors and has been associated with increased mortality among liver transplant candidates. However, evidence about this population's frailty prevalence and mortality is inconsistent and needs to be clarified. This study aimed to quantitatively synthesize the prevalence of frailty and the role of frailty on mortality in liver transplant candidates.
All eligible studies published in Embase, PubMed, Scopus, and Web of Science from inception until March 5, 2024, were included. The pooled prevalence and hazard ratio (HR) corresponding to 95 % confidence intervals (CI) in mortality estimates were conducted. The random-effects model was used for the calculations.
A total of 17 studies containing 4509 patients with liver transplant waitlist candidates were included. The prevalence of frailty in liver transplant waitlist candidates was 32 % (95 % CI = 25-38; p < 0.01). In this population, frailty was associated with an increased hazard ratio for mortality (8 studies) (HR = 2.49; 95 % CI = 1.77-3.51; p < 0.01). Furthermore, subgroup analysis showed that frailty was associated with a higher mortality in the USA (HR = 4.03; 95 % CI = 1.77-3.51; p < 0.01) compared with the non-USA area (HR = 2.03; 95 % CI = 1.51-2.72; p < 0.01).
Our results suggest that frailty is prevalent in patients awaiting liver transplants, which strongly predicts waitlist mortality among this population. These findings highlight the importance of frailty in the decision of transplantation and in designing studies that consider frailty. Reducing the severity or impact of frailty on this population may improve prognosis.
身体虚弱会增加对压力源的易感性，并与肝移植候选者的死亡率增加有关。然而，关于这一人群虚弱的流行率和死亡率的证据并不一致，需要加以澄清。本研究旨在定量综合肝移植候选者虚弱的流行率和虚弱对死亡率的作用。
从开始到 2024 年 3 月 5 日，在 Embase、PubMed、Scopus 和 Web of Science 中纳入所有已发表的符合条件的研究。进行了虚弱的汇总患病率和死亡率估计值对应的风险比（HR）（95%置信区间[CI]）。计算采用随机效应模型。
共纳入 17 项研究，包含 4509 例肝移植候补患者。肝移植候补患者中虚弱的流行率为 32%（95%CI=25-38；p<0.01）。在这一人群中，虚弱与死亡率的风险比增加相关（8 项研究）（HR=2.49；95%CI=1.77-3.51；p<0.01）。此外，亚组分析表明，与非美国地区相比，虚弱与美国地区更高的死亡率相关（HR=4.03；95%CI=1.77-3.51；p<0.01）（HR=2.03；95%CI=1.51-2.72；p<0.01）。
我们的结果表明，虚弱在等待肝移植的患者中很常见，这强烈预测了该人群在候补名单上的死亡率。这些发现强调了虚弱在移植决策和设计考虑虚弱的研究中的重要性。减轻该人群虚弱的严重程度或影响可能会改善预后。
