# Predicting post-transplant mortality and global functional health based on pre-transplant functional status in liver transplantation

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2021 · $667,233

## Abstract

PROJECT SUMMARY
The decision to proceed with liver transplantation in a patient with end-stage liver disease depends not just on
the risk of death without transplant but the risk of adverse outcomes after it. The transplant clinician's assess-
ment of a cirrhotic patient's global functional health – which we have conceptualized as his or her vulnerability
to health stressors – is a critical factor (oftentimes the sole factor) in this decision. Yet at the current time, no
standardized, objective criteria for poor global functional health exist to define who is “too frail for transplant”.
Rather, assessment of functional status in transplant is subjective and is applied to decision-making ad hoc,
resulting in unequal transplant access and potential denial of otherwise suitable candidates. To facilitate
transplant decision-making, a precise understanding of how pre-transplant functional status impacts post-
transplant outcomes is needed to inform prediction of who will not regain excellent global functional health after
transplant. We have demonstrated that tools to quantify frailty and functional status in older adults have proven
valuable to measure global functional health in cirrhotic patients and have developed an objective Liver Frailty
Index, consisting of a composite of performance-based tests (grip strength, chairs stands, and balance
testing), to capture longitudinal changes in functional status specifically for use in the pre- and post-transplant
settings. Building logically upon this work, we propose to determine the impact of pre-transplant functional
status on 1-year post-transplant mortality and global functional health and develop/validate clinical prediction
rules for these outcomes that incorporate pre-transplant functional status. To accomplish these goals, we will
leverage our existing Multi-center Functional Assessment in Liver Transplantation Study, consisting of 5 US
liver transplant centers (UCSF, Johns Hopkins, Columbia, Baylor, and Duke) with a track record of
collaboration and high-impact research to obtain data on a minimum of 1,300 liver transplant recipients with
assessments of functional status pre-transplantation and assessments of global functional health (including the
Liver Frailty Index, disability, and quality of life) 1-year post-transplantation. These data will be used to develop
and validate clinical prediction rules that incorporate both pre-transplant functional status, patient and donor
characteristics to predict death, functional status, disability, and quality of life 1-year after transplantation. This
project will positively impact the field by expanding our ability to measure the benefit of transplant both by how
long a recipient will live as well as by how well a recipient will live after liver transplantation. Importantly, this
project will facilitate clinical decision-making for patients and their clinicians through the precise understanding
of how functional status impacts outcomes and what patients...

## Key facts

- **NIH application ID:** 10221569
- **Project number:** 5R01AG059183-04
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Jennifer C. Lai
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $667,233
- **Award type:** 5
- **Project period:** 2018-06-15 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10221569

## Citation

> US National Institutes of Health, RePORTER application 10221569, Predicting post-transplant mortality and global functional health based on pre-transplant functional status in liver transplantation (5R01AG059183-04). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10221569. Licensed CC0.

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