Functional Assessment in Liver Transplantation

Study Overview
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Brief Summary
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In order to ensure the equity of the liver allocation process, it is important to create objective, scientifically validated markers of frailty in patients with end-stage liver disease that accurately predict patient outcomes. Many measures have been developed to assess this clinical state in elderly patients, but none have been applied to patients with cirrhosis, a population at increased risk for accelerated functional decline. This protocol is designed to learn more about the effects of functional status (also known as frailty) in liver transplant patients and patient outcomes both before and after liver transplant.

Detailed Description
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Subjects in this study will be asked questions regarding functional status and ability to do activities at home. Subjects will also be asked to complete several physical tests to assess functional status. For example, subjects will be asked to stand up from a chair several times, balance with their feet together, and walk down a hall as quickly as possible. Subjects will also be asked to perform a hand grip strength test. Subjects will be assessed at baseline and at every clinic visit in the pre-transplant setting. Subjects will again be assessed at 3, 6, and 12 months post-transplant.

Official Title
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Functional Assessment in Liver Transplantation

Conditions
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Cirrhosis, End Stage Liver Disease

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults (≥18 years old) Listed for liver transplantation, or are listable - i.e, have undergone formal evaluation and been approved for listing if/when patients achieve high enough priority Are seen in the outpatient clinic setting Exclusion Criteria: Have severe hepatic encephalopathy at enrollment (defined by the time to complete the Numbers Connection Test (NCT) > 120 seconds, which is the first test that the participants complete upon enrollment).

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fried Frailty Index measurements in 300 patients with end-stage liver disease awaiting liver transplantation | Fried Frailty is calculated by combining into one score measurements of: Exhaustion: number of days patient felt exhaustion in the past 7 days Physical activity: has the subject performed any weight bearing activity in the past month? (Possible answers: yes or no). Grip strength test using dynamometer: Three measurements reported in kg. Walking speed in a 13-foot (4 meters) walk: Three measurements reported in seconds Unintentional Weight Loss: report if patient has lost 10 lbs or more in the last year. Minnesota Leisure Time Physical Activity Questionnaire (MNLTPA) calculated as a value of 1 for males with MNLTPA score less than 383 kcal/week and for females with a score less than 270 kcal/week. Range of score is 0 to 5 with 0 being not frail and 5 being most frail | 5 years | 
| Liver Frailty Index measurements in 300 patients with end-stage liver disease awaiting liver transplantation | The following measurements are used individually to assess liver frailty index: Chair stands: The patient stands up from a sitting position without using his/her arms. The time (in seconds) the patient requires to complete the task is reported. Balance testing: patients must stand up in side by side, semi tandem and tandem positions for 10 seconds each. If the subject can't hold position for 10 seconds, the number of seconds that the subject kept in position is reported. Scoring range is 1.0 to 7.0 with 1.0 to 3.0 being robust and 4.5 to 7.0 being frail | 5 years | 
| Numbers Connection test measurements in 300 patients with end-stage liver disease | Patient connects numbers that are scattered at random on a piece of paper. Reported as time (in seconds) taken to connect the numbers. | 5 years | 
| Work status | Possible answers: working, retired, on disability, other. | 5 years | 
| Hospitalizations | Possible answers: yes or no. If yes, report #of nights and reason. | 5 years | 
| Activities of daily living (ADLs) | Six questions about daily activities Scoring: A response of yes to any of the questions receives a value of 1. the ADL score is measured as the sum of the values of the 6 questions. A score of 0 correlates with most dependent and a score of 6 is most independent. | At 1 year post transplantation | 
| Instrumental Activities of Daily Living (IADLs) | Eight questions about daily activities: Scoring: each question can be answered with a score of 0 or 1. The final iADL score is the sum of all values. The range of the score is 0 to 8 with 0 being most dependent and 8 being most independent.' | At 1 year post transplantation | 
| 36 Item Short Form Survey Instrument (SF-36) | Patient will complete a 36 question questionnaire about quality of life at 1 year post transplantation. | At 1 year post transplantation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Correlation between frailty and outcomes both before and after liver transplantation. | The association between the subject's frailty score and their pre and post transplant outcomes will be assessed. | 5 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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frailty, liver transplantation, functional status