{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T14:27:57Z","timestamp":1762957677851,"version":"build-2065373602"},"reference-count":32,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T00:00:00Z","timestamp":1744588800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100012317","name":"Astellas Pharma Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012317","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Frailty is a phenotype of cumulative decline leading to decreased physiologic reserve and vulnerability to stressors. Frailty is associated with adverse outcomes after liver transplantation (LT) in adults, but similar data are not available in children. A prospective multicenter study previously determined that frailty is present in 46% of children with end\u2010stage liver disease (ESLD). We utilized this cohort to evaluate the impact of pre\u2010transplant frailty on post\u2010LT outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study included pediatric participants from the original frailty study across 10 North American transplant centers who had subsequently undergone LT. Clinical outcomes were collected up to 1\u2009year post LT. Participants were stratified by their pre\u2010transplant frailty score (defined by a pre\u2010LT frailty score of \u2265\u20096.0) and long\u2010term outcomes were compared between groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>28 (60.7% female, 46.4% biliary atresia) pediatric LT recipients were included, and 54% of children met criteria for frailty (<jats:italic>n<\/jats:italic>\u2009=\u200915). Baseline characteristics were comparable between groups; however, those with frailty were significantly more likely to have pre\u2010transplant failure to thrive (33.3% vs. 0%, <jats:italic>p<\/jats:italic>\u2009=\u20090.044). Thirty\u2010four hospital readmissions (22 in frail and 12 in non\u2010frail children) occurred in 20 patients. Higher pre\u2010transplant frailty scores were also significantly associated with an increased number of readmissions after transplantation (<jats:italic>p<\/jats:italic>\u2009=\u20090.034).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Pediatric frailty may be associated with the adverse outcome of increased frequency of hospitalization in the first year after pediatric liver transplantation. These data support the concept that frail children should be identified and targeted for prehabilitation prior to LT.<\/jats:p><\/jats:sec>","DOI":"10.1111\/petr.70077","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T01:44:09Z","timestamp":1744681449000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Frailty in Pediatric Liver Disease May Be Associated With an Increased Incidence of Readmissions After Pediatric Liver Transplantation"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7569-1238","authenticated-orcid":false,"given":"Saleh A.","family":"Alqahtani","sequence":"first","affiliation":[{"name":"Department of Pediatrics Imam Abdulrahman Bin Faisal University  Dammam Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Shpoliansky","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition The Hospital for Sick Children  Toronto Ontario Canada"},{"name":"University of Toronto  Toronto Ontario Canada"},{"name":"Health Sciences Centre University of Manitoba  Winnipeg Manitoba Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shannon M.","family":"Vandriel","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition The Hospital for Sick Children  Toronto Ontario Canada"},{"name":"University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatema","family":"Johara","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition The Hospital for Sick Children  Toronto Ontario Canada"},{"name":"University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Quammie","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition The Hospital for Sick Children  Toronto Ontario Canada"},{"name":"University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eberhard","family":"Lurz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Gastroenterology and Hepatology Dr. von Hauner Children's Hospital, University Hospital, LMU  Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Estella M.","family":"Alonso","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition Ann &amp; Robert H. Lurie Children's Hospital of Chicago  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James F.","family":"Daniel","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology Children's Mercy Hospital  Kansas City Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veena L.","family":"Venkat","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology and Nutrition Children's Hospital of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel H.","family":"Leung","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition Texas Children's Hospital  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie","family":"Economides","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition Texas Children's Hospital  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4359-7102","authenticated-orcid":false,"given":"Evelyn K.","family":"Hsu","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology University of Washington\u2010Seattle Children's Hospital  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen M.","family":"Loomes","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nitika A.","family":"Gupta","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition Children's Healthcare of Atlanta Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dana","family":"Mannino","sequence":"additional","affiliation":[{"name":"Division of Solid Organ Transplantation Nemours Children's Hospital  Wilmington Delaware USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jerome","family":"Menendez","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology Levine Children's Hospital Carolinas Health Care Center  Charlotte North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9998-5692","authenticated-orcid":false,"given":"Vicky L.","family":"Ng","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition The Hospital for Sick Children  Toronto Ontario Canada"},{"name":"University of Toronto  Toronto Ontario Canada"},{"name":"Transplant and Regenerative Medicine Centre Hospital for Sick Children  Toronto Ontario 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