2025: The Current State of Functional Assessment in Patients Undergoing Liver Transplantation

Purpose of Review: Frailty has emerged as an important factor in liver transplant evaluation, as frailty is common in cirrhosis and is associated with adverse outcomes before and after transplant. No standardized approach to frailty assessment exists in this patient population. This review will summarize the evidence for different frailty assessment tools that have been studied in liver transplant, and offer practical considerations for assessment in the clinical setting. Recent Findings: Major societies in the field have released consensus statements recommending regular assessment of frailty in all liver transplant candidates. A variety of subjective, survey-based and objective, performance-based tools have been studied. One tool is not superior, and frailty should be assessed at multiple time points given the potential for physical function to change over time, with resulting clinical implications. Summary: A balanced approach to frailty assessment may involve the use of composite metrics and frailty toolkits, incorporating multiple tools in a longitudinal fashion to produce a holistic assessment of a patient’s functional capacity.

Duke Scholars

Author Matthew Robert Kappus Medicine, Gastroenterology