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作用和潜在的协同作用，老年肝硬化患者处于不良健康结局的高风险中。虽然考虑肝移植的终末期肝病老年患者比例正在迅速上升，但移植临床医生缺乏客观衡量衰老相关因素（虚弱和功能状态）对移植结果的影响的工具。为了解决这一知识鸿沟，我在本提案中概述了3个研究目标。利用我正在进行的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)关联移植前措施

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.