Frailty and Functional Status in Older Liver Transplant Patients

描述(由申请人提供)：由于慢性肝功能衰竭和衰老过程的联合和潜在的协同作用，老年肝硬变患者的不良健康结果的风险很高。虽然老年终末期肝病患者考虑肝移植的比例正在迅速上升，但移植临床医生缺乏工具来客观地衡量衰老相关因素的虚弱和功能状态对移植结果的影响。为了解决这一知识差距，我在这份提案中概述了3个研究目标。利用我正在进行的对60岁等待肝移植的终末期肝病患者的前瞻性队列研究，我将：(1)相关的移植前措施 评估移植后2年内的脆弱和功能状态(目标1)和(2)在移植后3、6和12个月表征脆弱和功能状态(目标2)。利用我在担任研究员期间建立的美国肝脏移植中心联盟，我将在其他3个美国移植中心的120名60岁的肝移植候选人的试点队列中测试实施这些措施的可行性(目标3)。我是加州大学旧金山分校的肝病专家，专攻肝移植 弗朗西斯科。在老龄化研究支持的坚实基础上[NIA GEMSSTAR、T.Franklin Williams学者奖和加州大学旧金山分校老年美国人独立中心(OAIC)领航员奖]，这一老龄领域的Paul B.Beeson职业发展奖将使我成为一名独立的临床研究员，在老龄、肝病和移植学科的交叉领域开创研究。在老年病学(Covinsky)、肝病学(Terrault)、移植外科(Feng，Segev)和生物统计学(Boscardin)等多学科领导者的直接指导下，我将执行一项详细的职业发展计划，以加速我实现本建议中列出的四个关键职业目标的道路：(1)奠定核心老年学原理的基础；(2)获得纵向队列研究的分析技能；(3)获得多中心协作技能；(4)培养领导技能，以便全国努力将老年学结构整合到老年肝硬化患者的护理和他们选择进行肝移植的过程中。作为我五年计划的一部分，我将积极参与老龄化和生物统计学以及跨学科职业发展和领导力方面的课程作业和结构化教程 程序。此外，通过加州大学旧金山分校老年病学分部、加州大学旧金山分校OAIC和包括比森会议在内的全国老年病学会议，我将把自己融入老龄研究社区，并为当前和未来的合作建立老年研究人员网络。相关性：确定脆弱和功能状态的特征及其与肝移植环境中结果的关系，可以阐明哪些人将获得可接受的移植结果，并迫使选定的老年肝硬变患者公平地接受移植。这项建议为R01将老年评估纳入所有老年终末期肝病患者的常规评估奠定了基础。

DESCRIPTION (provided by applicant): Older patients with cirrhosis are at high risk for adverse health outcomes due to the combined, and potentially synergistic, effects of chronic liver failure and aging processes. While the proportion of older patients with end-stage liver disease considering liver transplantation is rapidly escalating, transplant clinicians lack tools t objectively measure the impact of the aging-related factors of frailty and functional status on transplant outcomes. To address this knowledge gap, I have outlined 3 research aims in this proposal. Leveraging my ongoing prospective cohort study of patients with end-stage liver disease e60 years old awaiting liver transplantation, I will: (1) associate pre-transplant measures of frailty and functional status with outcomes within 2 years of transplant (Aim 1) and (2) characterize frailty and functional status at 3, 6, and 12 months after transplant (Aim 2). Utilizig a consortium of U.S. liver transplant centers that I have established during my fellowship, I will test the feasibility of administering these measures of frailty and functional status in a pilot cohort of 120 liver transplant candidates �60 years old at 3 other U.S. transplant centers (Aim 3). I am a hepatologist specializing in liver transplantation at the University of California, San Francisco. Building upon a strong foundation of aging research support [NIA GEMSSTAR, T. Franklin Williams Scholar Award, and a UCSF Older Americans Independence Center (OAIC) Pilot Award], this Paul B. Beeson Career Development Award in Aging will establish me as an independent clinical investigator pioneering research at the intersection of aging, hepatology, and transplant disciplines. Under the direct supervision of a multidisciplinary team of leaders in geriatrics (Covinsky), hepatology (Terrault), transplant surgery (Feng, Segev), and biostatistics (Boscardin), I will execute a detailed career development plan to accelerate my path toward 4 key career goals outlined in this proposal: (1) to develop a foundation of core gerontologic principles; (2) to acquire analytic skills for longitudinal cohort studies; (3) to gain skills in mlti-center collaboration; (4) to cultivate leadership skills for national efforts to integrate geriatri constructs into the care of older patients with cirrhosis and their selection for liver transplantation. As part of my 5-year plan, I will actively engage in coursework and structured tutorials in aging and biostatistics as well as interdisciplinary career development and leadership programs. In addition, through the UCSF Division of Geriatrics, UCSF OAIC, and national geriatrics conferences including the Beeson meeting, I will integrate myself into the aging research community and establish a network of aging researchers for current and future collaboration. RELEVANCE: Characterizing frailty and functional status and its association with outcomes in the liver transplant setting can elucidate those who will achieve acceptable transplant outcomes and compel equitable access to transplant in select older cirrhotics. This proposal lays the groundwork for an R01 to incorporate geriatric assessments into the routine evaluation of all older patients with end-stage liver disease.