Background: Frailty has been proven to be associated with mortality after orthotopic
heart transplantation (OHT). The aim of our study was to determine the impact of frailty
on mortality in the current era using pretransplant mechanical cardiac support (MCS).
Methods: We retrospectively calculated the frailty scores of 471 patients undergoing
OHT in a single institution between January 2012 and August 2022. The outcome was
all-cause mortality. Results: The median survival time was 1987 days (IQR: 1487 days)
for all patients. In total, 266 (56.5%) patients were categorized as nonfrail, 179
(38.0%) as prefrail, and 26 (5.5%) as frail. The survival rates were 0.73, 0.54, and
0.28 for nonfrail, prefrail, and frail patients, respectively. The frailty score was
associated with mortality [HR: 1.34 (95% CI: 1.22–1.47, p < 0.001)]. Among the components
of the frailty score, age above 50 years, creatinine ≥ 3.0 mg/dL or prior dialysis,
and hospitalization before OHT were independently associated with mortality. Continuous-flow
left ventricular assist devices (CF-LVAD) were associated with an increased risk for
all-cause mortality [AHR: 1.80 (95% CI: 1.01–3.24, p = 0.047)]. Conclusions: The components
of the frailty score were not equally associated with mortality. Frailty and pretransplant
MCS should be included in the risk estimation.
