{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:44:41Z","timestamp":1791999881159,"version":"4.4.0"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Minufiya University"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Gastroenterol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The MELD score, while central to liver transplant prioritization, fails to capture frailty, an important predictor of transplant eligibility and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To assess the impact of frailty on transplant eligibility and compare its predictive accuracy to MELD-Na.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We prospectively studied adults with cirrhosis referred to for transplant evaluation. Frailty was assessed using the Clinical Frailty Scale (CFS) by a multidisciplinary team, with adjudication for disagreements. Laboratory data were collected, MELD scores calculated, and transplant eligibility determined using our institutional framework. Correlation, logistic regression, and ROC analyses compared MELD and CFS in predicting eligibility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 672 patients evaluated, 76 (11.3%) met the primary endpoint of transplant eligibility. Eligible patients had significantly lower MELD scores, but better frailty status compared with ineligible patients (mean CFS 3.2 vs. 5.8,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). CFS correlated moderately with MELD (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.62) and showed superior predictive accuracy for eligibility (AUC 0.84 vs. 0.72).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Frailty, assessed by the Clinical Frailty Scale, outperformed MELD-Na in predicting transplant eligibility and proved relevant even in low-MELD populations. These findings highlight frailty as a practical determinant of eligibility and a step toward standardized, evidence-based equitable selection frameworks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12876-025-04333-9","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T06:42:05Z","timestamp":1761028925000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Frailty and liver transplant eligibility beyond MELD scores: integrating functional status into candidate selection"],"prefix":"10.1186","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3110-1547","authenticated-orcid":false,"given":"Maha","family":"Elsabaawy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameh","family":"Afify","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warda","family":"Othman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amr","family":"Ragab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,21]]},"reference":[{"issue":"suppl 1","key":"4333_CR1","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1111\/ajt.14559","volume":"18","author":"WR Kim","year":"2018","unstructured":"Kim WR, Lake JR, Smith JM, et al. OPTN\/SRTR 2016 annual data report: liver. Am J Transpl. 2018;18(suppl 1):172\u2013253. https:\/\/doi.org\/10.1111\/ajt.14559.","journal-title":"Am J Transpl"},{"issue":"4","key":"4333_CR2","doi-asserted-by":"publisher","first-page":"e545","DOI":"10.1097\/TXD.0000000000000997","volume":"6","author":"JB Cywinski","year":"2020","unstructured":"Cywinski JB, Makarova N, Arney A, et al. Resource utilization after liver transplantation in patients with and without hepatopulmonary syndrome: Cleveland clinic experience. Transpl Direct. 2020;6(4):e545. https:\/\/doi.org\/10.1097\/TXD.0000000000000997.","journal-title":"Transpl Direct"},{"issue":"6","key":"4333_CR3","doi-asserted-by":"publisher","first-page":"1318","DOI":"10.1016\/j.jhep.2022.02.013","volume":"76","author":"J Ge","year":"2022","unstructured":"Ge J, Kim WR, Lai JC, Kwong AJ. Beyond MELD \u2013 Emerging strategies and technologies for improving mortality prediction, organ allocation, and outcomes in liver transplantation. J Hepatol. 2022;76(6):1318\u201329. https:\/\/doi.org\/10.1016\/j.jhep.2022.02.013.","journal-title":"J Hepatol"},{"issue":"6","key":"4333_CR4","doi-asserted-by":"publisher","first-page":"1675","DOI":"10.1053\/j.gastro.2019.01.028","volume":"156","author":"JC Lai","year":"2019","unstructured":"Lai JC, Rahimi RS, Verna EC, et al. Frailty associated with waitlist mortality independent of ascites and hepatic encephalopathy in a multicenter study. Gastroenterology. 2019;156(6):1675\u201382. https:\/\/doi.org\/10.1053\/j.gastro.2019.01.028.","journal-title":"Gastroenterology"},{"issue":"6","key":"4333_CR5","doi-asserted-by":"publisher","first-page":"1132","DOI":"10.1097\/SLA.0000000000003207","volume":"271","author":"CE Haugen","year":"2020","unstructured":"Haugen CE, McAdams-DeMarco M, Holscher CM, et al. Multicenter study of age, frailty, and waitlist mortality among liver transplant candidates. Ann Surg. 2020;271(6):1132\u20136. https:\/\/doi.org\/10.1097\/SLA.0000000000003207.","journal-title":"Ann Surg"},{"issue":"7","key":"4333_CR6","doi-asserted-by":"publisher","first-page":"e00211","DOI":"10.14309\/ctg.0000000000000211","volume":"11","author":"WM Kremer","year":"2020","unstructured":"Kremer WM, Nagel M, Reuter M, et al. Validation of the clinical frailty scale for the prediction of mortality in patients with liver cirrhosis. Clin Transl Gastroenterol. 2020;11(7):e00211. https:\/\/doi.org\/10.14309\/ctg.0000000000000211.","journal-title":"Clin Transl Gastroenterol"},{"issue":"8","key":"4333_CR7","doi-asserted-by":"publisher","first-page":"1870","DOI":"10.1111\/ajt.12762","volume":"14","author":"JC Lai","year":"2014","unstructured":"Lai JC, Feng S, Terrault NA, et al. Frailty predicts waitlist mortality in liver transplant candidates. Am J Transplant. 2014;14(8):1870\u20139. https:\/\/doi.org\/10.1111\/ajt.12762.","journal-title":"Am J Transplant"},{"issue":"7","key":"4333_CR8","doi-asserted-by":"publisher","first-page":"1896","DOI":"10.1111\/ajt.15392","volume":"19","author":"JC Lai","year":"2019","unstructured":"Lai JC, Sonnenday CJ, Tapper EB, et al. Frailty in liver transplantation: an expert opinion statement from the American Society of Transplantation Liver and Intestinal Community of Practice. Am J Transplant. 2019;19(7):1896\u2013906. https:\/\/doi.org\/10.1111\/ajt.15392.","journal-title":"Am J Transplant"},{"issue":"3","key":"4333_CR9","doi-asserted-by":"publisher","first-page":"1611","DOI":"10.1002\/hep.31848","volume":"74","author":"JC Lai","year":"2021","unstructured":"Lai JC, Tandon P, Bernal W, et al. Malnutrition, frailty, and sarcopenia in patients with cirrhosis: 2021 practice guidance by the American association for the study of liver diseases. Hepatology. 2021;74(3):1611\u201344. https:\/\/doi.org\/10.1002\/hep.31848.","journal-title":"Hepatology"},{"key":"4333_CR10","doi-asserted-by":"publisher","DOI":"10.2196\/60683","volume":"13","author":"WZ Tang","year":"2025","unstructured":"Tang WZ, Zhu SR, Mo ST, et al. Predictive value of frailty on outcomes of patients with cirrhosis: systematic review and meta-analysis. JMIR Med Inform. 2025;13:e60683. https:\/\/doi.org\/10.2196\/60683.","journal-title":"JMIR Med Inform"},{"issue":"3","key":"4333_CR11","doi-asserted-by":"publisher","DOI":"10.5500\/wjt.v15.i3.104500","volume":"15","author":"H Pahari","year":"2025","unstructured":"Pahari H, Tripathi S, Nundy S. Frailty as a determinant of liver transplant outcomes: a call for integrative strategies. World J Transplant. 2025;15(3):104500. https:\/\/doi.org\/10.5500\/wjt.v15.i3.104500.","journal-title":"World J Transplant"},{"issue":"11","key":"4333_CR12","doi-asserted-by":"publisher","first-page":"3350","DOI":"10.1007\/s10620-019-06034-2","volume":"65","author":"HW Chen","year":"2020","unstructured":"Chen HW, Ferrando A, White MG, et al. Home-based physical activity and diet intervention to improve physical function in advanced liver disease: a randomized pilot trial. Dig Dis Sci. 2020;65(11):3350\u20139. https:\/\/doi.org\/10.1007\/s10620-019-06034-2.","journal-title":"Dig Dis Sci"},{"issue":"10","key":"4333_CR13","doi-asserted-by":"publisher","first-page":"1324","DOI":"10.1002\/lt.24506","volume":"22","author":"MA Dunn","year":"2016","unstructured":"Dunn MA, Josbeno DA, Schmotzer AR, et al. The gap between clinically assessed physical performance and objective physical activity in liver transplant candidates. Liver Transpl. 2016;22(10):1324\u201332. https:\/\/doi.org\/10.1002\/lt.24506.","journal-title":"Liver Transpl"},{"issue":"3","key":"4333_CR14","doi-asserted-by":"publisher","first-page":"635","DOI":"10.5083\/ejcm\/25-03-108","volume":"15","author":"R Singh","year":"2025","unstructured":"Singh R, Gupta A, Chandail V. Frailty assessment in patient with liver cirrhosis \u2013 A tertiary care centre study in North India (J&K). Eur J Cardiovasc Med. 2025;15(3):635\u201341. https:\/\/doi.org\/10.5083\/ejcm\/25-03-108.","journal-title":"Eur J Cardiovasc Med"}],"container-title":["BMC Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-025-04333-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12876-025-04333-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-025-04333-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T10:07:49Z","timestamp":1761127669000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcgastroenterol.biomedcentral.com\/articles\/10.1186\/s12876-025-04333-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,21]]},"references-count":14,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["4333"],"URL":"https:\/\/doi.org\/10.1186\/s12876-025-04333-9","relation":{},"ISSN":["1471-230X"],"issn-type":[{"value":"1471-230X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,21]]},"assertion":[{"value":"21 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"\u201cThis study was performed following the principles of the Declaration of Helsinki. This study was approved by the Ethics Committee of the National Liver Institute, Menoufia University as unique research and not a part of an approved student thesis. Informed consent was obtained from all patients or their legal representatives before the study\u2019s enrolment.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"743"}}