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（由申请人提供）：由于慢性肝衰竭和衰老过程的综合和潜在的协同作用，老年肝硬化患者面临着不良健康结果的高风险，而考虑到患有终末期肝病的老年患者的比例。肝移植正在迅速升级，移植缺乏客观衡量衰弱和功能状态等衰老相关因素对移植结果的影响的工具，为了解决这一知识差距，我在本提案中概述了 3 个研究目标。利用我正在进行的对 60 岁左右等待肝移植的终末期肝病患者的前瞻性队列研究，我将：(1) 联合移植前措施 移植后 2 年内的虚弱和功能状态（目标 1）和（2）描述了移植后 3、6 和 12 个月的虚弱和功能状态（目标 2）。在我的研究期间，我将测试在 120 名肝移植候选者（60 岁、另外 3 名）中进行这些虚弱和功能状态测量的可行性。美国移植中心（目标 3）我是加州大学圣何塞分校的一名肝病专家，专门从事肝移植。 建立在老龄化研究支持的坚实基础上 [NIA GEMSSTAR、T. Franklin Williams 学者奖和加州大学旧金山分校美国老年人独立中心 (OAIC) 试点奖]，这项 Paul B. Beeson 老龄化职业发展奖将设立我作为一名独立的临床研究者，在老年病学（Covinsky）、肝病学（Terrault）、移植手术领域的多学科领导团队的直接监督下，在衰老、肝病学和移植学科的交叉领域进行开拓性研究。 （Feng，Segev）和生物统计学（Boscardin），我将执行详细的职业发展计划，以加速实现本提案中概述的 4 个关键职业目标：（1）建立核心老年学原则的基础；（2）获得纵向队列研究的分析技能；(3) 获得多边医疗机构中心合作的技能；(4) 将国家老年病学建设的领导技能纳入老年肝硬化患者的护理及其选择中。作为我五年计划的一部分，我将积极参与衰老和生物统计学以及跨学科职业发展和领导力方面的课程和结构化教程。 此外，通过加州大学旧金山分校老年病学部、加州大学旧金山分校 OAIC 和包括 Beeson 会议在内的全国老年病学会议，我将融入老龄化研究界，并建立一个老龄化研究人员网络，以促进当前和未来的合作：表征脆弱。功能状态及其与肝移植结果的关系可以阐明那些将获得可接受的移植结果的人，并迫使选定的老年肝硬化患者公平地获得移植。 R01 将老年评估纳入所有患有终末期肝病的老年患者的常规评估中。