Development of the Lung Transplant Frailty Scale (LT-FS)

Singer, Jonathan P.; Christie, Jason D.; Diamond, Joshua M.; Anderson, Michaela A.; Benvenuto, Luke; Gao, Ying; Arcasoy, Selim M.; Lederer, David J.; Calabrese, Daniel R.; Wang, Ping; Hays, Steve; Kukreja, Jasleen; Venado, Aida; Kolaitis, N.A.; Leard, Lorriana E.; Shah, Rupal J.; Kleinhenz, Mary Ellen; Golden, Jeffrey A.; Betancourt, Legna; Oyster, Michelle; Zaleski, Derek; Adler, Joe; Kalman, Laurel; Balar, Priya; Patel, Shreena; Medikonda, Nikhila; Koons, Brittany; Tevald, Michael A.; Covinsky, Kenneth E.; Greenland, John R.; Katz, Patti K

doi:10.1016/j.healun.2023.02.006

Cited by 16 publications

(32 citation statements)

References 57 publications

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“…15 Given the importance of characterizing frailty-related LTx outcomes, 16 a consensus Lung Transplant Frailty Scale has just been developed for future detailed frailty evaluation. 17…”

Section: Frailtymentioning

confidence: 99%

“…While a successful LTx can reverse the frailty phenotype in the short term, recent studies have linked frailty to long term morbidity in the form of fracture risk 14 and CLAD 15 . Given the importance of characterizing frailty‐related LTx outcomes, 16 a consensus Lung Transplant Frailty Scale has just been developed for future detailed frailty evaluation 17 …”

Section: Lung Transplant Recipient Selectionmentioning

confidence: 99%

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Advances in lung transplantation: 60 years on

Paraskeva,

Snell

2024

Respirology

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Lung transplantation is a well‐established treatment for advanced lung disease, improving survival and quality of life. Over the last 60 years all aspects of lung transplantation have evolved significantly and exponential growth in transplant volume. This has been particularly evident over the last decade with a substantial increase in lung transplant numbers as a result of innovations in donor utilization procurement, including the use donation after circulatory death and ex‐vivo lung perfusion organs. Donor lungs have proved to be surprisingly robust, and therefore the donor pool is actually larger than previously thought. Parallel to this, lung transplant outcomes have continued to improve with improved acute management as well as microbiological and immunological insights and innovations. The management of lung transplant recipients continues to be complex and heavily dependent on a tertiary care multidisciplinary paradigm. Whilst long term outcomes continue to be limited by chronic lung allograft dysfunction improvements in diagnostics, mechanistic understanding and evolutions in treatment paradigms have all contributed to a median survival that in some centres approaches 10 years. As ongoing studies build on developing novel approaches to diagnosis and treatment of transplant complications and improvements in donor utilization more individuals will have the opportunity to benefit from lung transplantation. As has always been the case, early referral for transplant consideration is important to achieve best results.

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“…15 Given the importance of characterizing frailty-related LTx outcomes, 16 a consensus Lung Transplant Frailty Scale has just been developed for future detailed frailty evaluation. 17…”

Section: Frailtymentioning

confidence: 99%

Section: Lung Transplant Recipient Selectionmentioning

confidence: 99%

Advances in lung transplantation: 60 years on

Paraskeva,

Snell

2024

Respirology

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“…Patients with greater exercise capacity pretransplant, were found to have shorter hospital stays and favorable early outcomes [26–28]. In an attempt to identify objective criteria for the transplant candidate's overall fitness, a multicenter approach was taken to create a frailty scale specific to the lung transplant population; the lung transplant frailty scale [29 ▪▪ ]. The scale demonstrated superior predictive validity over previously established metrics including the short physical performance battery (SPPB) and Fried Frailty Phenotype (FFP).…”

Section: Frailtymentioning

confidence: 99%

Optimizing the prelung transplant candidate

Pagteilan,

Atay

2023

Current Opinion in Organ Transplantation

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Purpose of review Lung transplant outcomes are impacted by multiple modifiable risk factors. Candidate deterioration on the wait list remains problematic. Innovative technology and strategies to identify and impact pretransplant morbidity have improved short- and long-term outcomes. We focus our review on recent advances in pretransplant recipient assessment and optimization. Recent findings Advancements in recipient management have focused on risk factor identification for adverse outcomes and the development of a lung transplant specific frailty assessment. Early surgical correction of gastroesophageal reflux disease (GERD), including the use of partial fundoplication in the setting of esophageal dysmotility, leads to improvements in graft function/longevity. New evidence supports expanding criteria for extracorporeal life support as a bridge to transplant. Summary Candidate optimization requires early intervention to limit functional deterioration potentially contributing to adverse outcomes. Frailty can be identified with a transplant specific frailty assessment, and positively impacted with dedicated rehabilitation. Pretransplant frailty is reversible following transplant and should be considered in the context of overall fitness at the time of candidate selection. Invasive support modes including extracorporeal membrane oxygenation (ECMO) are appropriate to preserve strength and mobility, with awake, ambulatory ECMO preferred. The deleterious effect of GERD on graft function can be managed with early fundoplication over medical management alone.

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“…Although psychosocial, nutritional and physical impairments impact post-LTx outcomes,1 the clinical operationalisation of frailty measurement in LTx relates overwhelmingly to the physical domain 5 12 13. This may be due to the feasibility of data collection, the younger age of LTx candidates or the complexity associated with cumulative deficit models 12 14.…”

Section: Introductionmentioning

confidence: 99%

“…This may be due to the feasibility of data collection, the younger age of LTx candidates or the complexity associated with cumulative deficit models 12 14. The most commonly reported phenotypic frailty measures collected in clinical practice prior to LTx include the Short Physical Performance Battery (SPPB) and the Fried Frailty Phenotype (FFP) 13 15…”

Section: Introductionmentioning

confidence: 99%

Rehabilitation interventions to modify physical frailty in adults before lung transplantation: a systematic review protocol

McGarrigle,

Norman,

Hurst

et al. 2024

BMJ Open

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IntroductionLung transplantation is the gold-standard treatment for end-stage lung disease for a small group of patients meeting strict acceptance criteria after optimal medical management has failed. Physical frailty is prevalent in lung transplant candidates and has been linked to worse outcomes both on the waiting list and postoperatively. Exercise has been proven to be beneficial in optimising exercise capacity and quality of life in lung transplant candidates, but its impact on physical frailty is unknown. This review aims to assess the effectiveness of exercise interventions in modifying physical frailty for adults awaiting lung transplantation.Methods and analysisThis protocol was prospectively registered on the PROSPERO database. We will search four databases plus trial registries to identify primary studies of adult candidates for lung transplantation undertaking exercise interventions and assessing outcomes pertaining to physical frailty. Studies must include at least 10 participants. Article screening will be performed by two researchers independently at each stage. Extraction will be performed by one reviewer and checked by a second. The risk of bias in studies will be assessed by two independent reviewers using tools appropriate for the research design of each study; where appropriate, we will use Cochrane Risk of Bias 2 or ROBINS-I. At each stage of the review process, discrepancies will be resolved through a consensus or consultation with a third reviewer. Meta-analyses of frailty outcomes will be performed if possible and appropriate as will prespecified subgroup and sensitivity analyses. Where we are unable to perform meta-analysis, we will conduct narrative synthesis following Synthesis without Meta-analysis guidance. The review will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.Ethics and disseminationNo ethical issues are predicted due to the nature of this study. Dissemination will occur via conference abstracts, professional networks, peer-reviewed journals and patient support groups.PROSPERO registration numberCRD42022363730.

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Development of the Lung Transplant Frailty Scale (LT-FS)

Cited by 16 publications

References 57 publications

Advances in lung transplantation: 60 years on

Advances in lung transplantation: 60 years on

Optimizing the prelung transplant candidate

Rehabilitation interventions to modify physical frailty in adults before lung transplantation: a systematic review protocol

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