Frailty and Functional Status in Older Liver Transplant Patients

老年肝移植患者的虚弱和功能状态

• 批准号: 9064689
• 负责人: Jennifer C. Lai
• 金额: $ 15.23万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-15 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9064689
• 关键词: Address; Adult; Age; Aging; Aging-Related Process; American; Award; Biometry; Blood Tests; California; Caring; Cessation of life; Chronic; Cirrhosis; Clinical; Clinical Investigator; Clinical assessments; Cohort Studies; Collaborations; Communities; Comorbidity; Data Set; Demographic Aging; Development Plans; Discipline; Elderly; Epidemic; Evaluation; Exhibits; Fellowship; Foundations; Future; Geriatric Assessment; Geriatrics; Goals; Health; Hepatitis; Hepatology; Individual; Intuition; K-Series Research Career Programs; Knowledge; Laboratories; Leadership; Liver Failure; Liver diseases; Measures; Mentorship; Modeling; Operative Surgical Procedures; Outcome; Patients; Population; Recovery of Function; Research; Research Personnel; Research Support; Risk; San Francisco; Severity of illness; Staging; Structure; Supervision; Survival Rate; Testing; Training; Transplant Recipients; Transplantation; Universities; Waiting Lists; Work; age related; base; career; career development; chronic liver disease; cohort; data registry; disability; experience; frailty; functional status; high risk; improved; liver transplantation; medical specialties; meetings; mortality; multidisciplinary; non-alcoholic fatty liver; older patient; outcome forecast; programs; prospective; research and development; skills; symposium; tool

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.

描述（由适用提供）：肝硬化的老年患者由于慢性肝衰竭和衰老过程的综合和潜在的协同作用而导致健康状况不良的不良结果风险。尽管考虑肝移植的老年患者的年龄段肝病患者比例正在迅速上升，但移植临床医生缺乏工具t客观地衡量与衰老相关的脆弱因素和功能状况对移植结果的影响。为了解决这一知识差距，我概述了该提案的3个研究目的。利用我正在进行的前瞻性队列研究末期肝病E60岁的患者等待肝移植，我将：（1）副移植前测量 在移植后的2年内（AIM 1）和（2）在移植后3、6和12个月内表征脆弱和功能状态（AIM 2），具有脆弱和功能状态。我在奖学金期间建立的美国肝移植中心的一个联盟，我将测试在120个肝移植候选者中，在其他3个美国移植中心（AIM 3）中，在120个肝移植候选者中管理这些脆弱和功能状态的可行性。我是一名肝病学家 弗朗西斯科。 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 towards 4 key career goals outlined in this proposal: (1) to develop a foundation of core gerontologic principles; （2）获得纵向队列研究的分析技能； （3）获得MLTI-Center协作的技能； （4）培养领导能力，以为将老年肝硬化患者的护理及其选择肝脏移植纳入老年患者的护理。作为我5年计划的一部分，我将积极从事衰老和生物统计学以及跨学科职业发展和领导力的课程和结构化教程 程序。此外，通过UCSF老年科学，UCSF OAIC和包括Beeson会议在内的国家老年人会会议，我将把自己融入老化的研究社区，并建立一个老化研究人员的网络，以进行当前和未来的合作。相关性：表征脆弱和功能状态及其与肝脏移植设置中结果的关联可以阐明那些将获得可接受的移植成果的人，并强迫在精选较旧的cirrhotics中进行公平访问移植。该提案为R01的基础奠定了基础，以将老年评估纳入对所有终末期肝病患者的常规评估。