Frailty and aging-associated syndromes in lung transplant candidates and recipients

Abstract

Many lung transplant candidates and recipients are older and frailer compared to previous eras. Older patients are at increased risk for pre‐ and posttransplant mortality, but this risk is not explained by numerical age alone. This manuscript represents the product of the American Society of Transplantation (AST) conference on frailty. Experts in the field reviewed the latest published research on assessment of elderly and frail lung transplant candidates. Physical frailty, often defined as slowness, weakness, low physical activity, shrinking, and exhaustion, and frailty evaluation is an important tool for evaluation of age‐associated dysfunction. Another approach is assessment by cumulative deficits, and both types of frailty are common in lung transplant candidates. Frailty is associated with death or delisting before transplant, and may be associated with posttransplant mortality. Sarcopenia, cognitive dysfunction, depression, and nutrition are other important components for patient evaluation. Aging‐associated inflammation, telomere dysfunction, and adaptive immune system senescence may also contribute to frailty. Developing tools for frailty assessment and interventions holds promise for improving patient outcomes before and after lung transplantation.

Predictive value of chart‐based frailty evaluation for lung transplant candidates

“…26,27 The lack of association between frailty and age as seen in our study demonstrates the independence of these two constructs, fitting with the conceptual framework of frailty as independent from chronologic age. 13 Other studies using different frailty evaluations in lung transplantation have similarly demonstrated a lack of association between frailty and age. 28,29 In our study, frailty was associated with the number of hospital readmissions in the first year, but not LOS in the initial posttransplant hospitalization.…”

“…Frailty is common in older adults but is defined as a state of decreased physiologic reserve independent of age. Studies have found that frailty is linked with worse outcomes, including an increased risk of early post‐transplant mortality using a range of methods for assessing frailty 11,12,13,14,15 . In lung transplant patients, frailty has also been associated with an increase in rehospitalization 16 .…”

“…Studies have found that frailty is linked with worse outcomes, including an increased risk of early post-transplant mortality using a range of methods for assessing frailty. 11,12,13,14,15 In lung transplant patients, frailty has also been associated with an increase in rehospitalization. 16 Various frailty measures have been applied in solid organ transplants; however, there is no consensus on how to measure frailty.…”

Current recommendations regarding evaluation of cognitive functioning in organ transplant candidates

“…Another factor to consider in assessing cognition is increasing age and normative age-related cognitive changes, which may be of particular concern given the generally aging population in the United States and increasing age of transplant recipients [53,54]. Recent studies have also found that the prevalence of global cognitive impairment and cognitive impairment burden steadily increased with age in kidney transplant populations [55 ▪ ].…”

Frailty predicts outcomes in cystic fibrosis patients listed for lung transplantation

“…25 Recent consensus reports have endorsed the development of frailty assessment tools as a future direction of research for transplantation studies. [26][27][28] We hypothesized that the FI could integrate the multiple elements routinely assessed during CF and LT evaluation to quantify risk and that, although LT would improve pulmonary impairment, increased frailty and social/lifestyle vulnerability would negatively impact post-LT outcomes. Our aim was to develop a CF-specific FI to allow risk stratification of CF patients listed for LT and to validate this approach in an independent cohort.…”