Robert Rahimi
Baylor University Medical Center USA
Title: Overt hepatic encephalopathy in cirrhotics listed for liver transplant in the setting of frailty
Biography
Biography: Robert Rahimi
Abstract
Background & Aim: Hepatic encephalopathy (HE) is a reversible neurocognitive
condition that has morbidity and mortality, and is associated with frequent
readmissions. With the increased recognition of frailty in decompensated
cirrhotics awaiting liver transplantation (LT), risk stratifi cation using frailty as
a surrogate marker on the susceptibility of developing overt HE (OHE) in this
population has not been well characterized. Th us, we aimed to describe the
prevalence and potential association (using frailty as a surrogate marker) of OHE
in patients listed for LT.
Methods: We evaluated 71 patients listed for LT between October 2015 and
May 2018, who demonstrated frailty, using the Liver Frailty Index (LFI) ≥4.5
for stratifi cation. On the same day as LFI testing, HE episodes were determined
prospectively from the time of LT listing. Logistic regression assessed associations
between frailty and OHE. Th e relationship between frailty, HE and hospital
readmission were determined using Fisher’s exact tests.
Results: A total of 41/71 (58%) cirrhotic patients received LT; 17 (24%) were
delisted, and 13 (18%) patients are currently on the waitlist. Of the 41 LT
recipients, the majority were Caucasian (78%) with a mean age of 57.6±9.3 years
old, 58% were male, Hepatitis C virus, alcoholic and non-alcoholic liver diseases
were the leading etiologies (20%, 20% and 15%), respectively. Th e mean MELD-
Na was 18.6 and mean albumin of 3 mg/dl. At the time of LT listing, 34/71 (48%)
demonstrated frailty, of which 22/34 (65%) were admitted for OHE compared to
12/34 (35%) without OHE, p=0.23. Overall, more females (11/17; 65%) compared
to males (6/23; 26%) demonstrated signifi cantly more OHE episodes (p=0.02),
with no diff erences in lactulose+rifaximin therapy observed between the groups.
Th e odds of frailty were higher in patients with HE (OR 1.94; 95% CI=0.75-5.0).
Among the frail cirrhotics who were delisted, a higher number of patients (40%)
demonstrated a prior episode of HE, compared to those without prior HE (24%),
which did not reach statistical signifi cance.
Conclusion: HE and frailty are commonly seen among cirrhotic patients listed
for LT and may contribute to higher delisting rates. Furthermore, frailty may
predispose to higher OHE episodes, which may be seen in higher rates in females,
however larger multicenter studies are needed.