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World J Hepatol. Mar 27, 2026; 18(3): 114279
Published online Mar 27, 2026. doi: 10.4254/wjh.v18.i3.114279
Published online Mar 27, 2026. doi: 10.4254/wjh.v18.i3.114279
Clinical burden of physical frailty in patients evaluated for liver transplantation: A retrospective cohort study
Heidi E Johnston, Hannah E Mayr, Tahnie G Takefala, Ingrid J Hickman, Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane 4102, Queensland, Australia
Heidi E Johnston, Hannah E Mayr, Melita E Andelkovic, Ingrid J Hickman, Graeme A Macdonald, Faculty of Medicine, The University of Queensland, Brisbane 4067, Queensland, Australia
Heidi E Johnston, Melita E Andelkovic, Tahnie G Takefala, Graeme A Macdonald, Queensland Liver Transplant Service, Princess Alexandra Hospital, Brisbane 4102, Queensland, Australia
Hannah E Mayr, Centre for Functioning and Health Research, Metro South Health, Brisbane 4102, Queensland, Australia
Melita E Andelkovic, Graeme A Macdonald, Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane 4102, Queensland, Australia
Yanyan Chen, Aaron P Thrift, Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX 77001, United States
Aaron P Thrift, Dan L Duncan Comprehensive Cancer Center, Department of Medicine, Baylor College of Medicine, Houston, TX 77001, United States
Ingrid J Hickman, ULTRA Team, The University of Queensland Clinical Trial Capability, The University of Queensland, Brisbane 4067, Queensland, Australia
Author contributions: Johnston HE, Mayr HE, Hickman IJ, and Macdonald GA were responsible for study concept and design, drafting of the manuscript, and administrative/technical or material support; Johnston HE, Andelkovic ME, and Takefala TG collected the data; Johnston HE, Mayr HE, Chen Y, Thrift AP, Hickman IJ, and Macdonald GA performed data analysis and interpretation as well as statistical analysis; Johnston HE, Mayr HE, Andelkovic ME, Takefala TG, Chen Y, Thrift AP, Hickman IJ, and Macdonald GA critically revised the manuscript for important intellectual content; Johnston HE obtained funding; and all authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Metro South Health, approval No. HREC/2018/QMS/46728.
Informed consent statement: The informed consent was waived by the Institutional Review Board.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets generated and analysed during the current study are not publicly available because they contain sensitive patient information. De-identified data may be made available from the corresponding author on reasonable request
Corresponding author: Heidi E Johnston, PhD, Nutrition and Dietetics, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba QLD 4102, Brisbane 4102, Queensland, Aus
Received: September 16, 2025
Revised: December 17, 2025
Accepted: January 22, 2026
Published online: March 27, 2026
Processing time: 192 Days and 1.2 Hours
Revised: December 17, 2025
Accepted: January 22, 2026
Published online: March 27, 2026
Processing time: 192 Days and 1.2 Hours
Core Tip
Core Tip: Frailty is increasingly recognized as a predictor of adverse outcomes in liver transplantation (LT), yet evidence using the liver frailty index (LFI) outside the United States is limited. This study is the first to evaluate the LFI in an Australian LT cohort, demonstrating its ability to identify patients at higher risk of waitlist mortality, unplanned hospitalizations, and prolonged intensive care unit stay after LT. These findings validate the LFI as a valuable tool for risk stratification, supporting its integration into LT assessment to guide surveillance and resource allocation for interventions.