A frailty index predicts post-liver transplant morbidity and mortality in HIV-positive patients

Background We hypothesized that frailty acts as a measure of health outcomes in the context of LT. The aim of this study was to explore frailty index across LT, as a measure of morbidity and mortality. This was a retrospective observational study including all consecutive 47 HIV+patients who received LT in Modena, Italy from 2003 to June 2015. Methods frailty index (FI) was constructed from 30 health variables. It was used both as a continuous score and as a categorical variable, defining ‘most frail’ a FI > 0.45. FI change across transplant (deltaFI, Δ FI ) was calculated as the difference between year 1 FI (FI–Y1) and pre-transplant FI (FI–t0). The outcomes measures were mortality and “otpimal LT” (defined as being alive without multi-morbidity). Results Median value of FI–t0 was 0.48 (IQR 0.42–0.52), FI–Y1 was 0.31 (IQR 0.26–0.41). At year five mortality rate was 45%, “optimal transplant” rate at year 1 was 38%. All the patients who died in the post-LT were most frail in the pre-LT. Δ FI was a predictor of mortality after correction for age and MELD (HR = 1.10, p = 0.006) and was inversely associated with optimal transplant after correction for age (HR = 1.04, p = 0.01). Conclusions We validated FI as a valuable health measure in HIV transplant. In particular, we found a relevant correlation between FI strata at baseline and mortality and a statistically significant correlation between, Δ FI and survival rate.