Frailty and clinical benefits with lung transplantation

Rozenberg, Dmitry; Mathur, Sunita; Wickerson, Lisa; Chowdhury, N.; Singer, Lianne G.

doi:10.1016/j.healun.2018.06.005

Cited by 55 publications

(40 citation statements)

References 67 publications

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“…Depending on the measure used, 10–45% of lung transplant candidates are frail at the time of assessment 10‐12 . Before transplant, both types of frailty are independently associated with worse exercise capacity by cardiopulmonary exercise testing, shorter distance walked in 6 minutes, and worse disability and health‐related quality of life (HRQL) 10‐13 . Preoperative frailty is also associated with increased risk of death or delisting from the waitlist 10 .…”

Section: Resultsmentioning

confidence: 99%

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

Schaenman

Diamond

Greenland

et al. 2021

American Journal of Transplantation

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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.

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Section: Resultsmentioning

confidence: 99%

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

Schaenman

Diamond

Greenland

et al. 2021

American Journal of Transplantation

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“…This imbalance of body composition does not necessarily have a negative effect on TTR or waiting list mortality. 37 Therefore, the paper indicated that frailty should be addressed in routine practice using clinical parameters such as BMI, albumin, and 6MWD. Frailty also is associated with waiting list mortality in liver transplant candidates.…”

Section: Discussionmentioning

confidence: 99%

“…36 The most recent paper showed that frail LTx candidates derived significant benefit in functional capacity and health-related quality of life despite significant disability pretransplant. 37 Therefore, the paper indicated that frailty should be addressed in routine practice using clinical parameters such as BMI, albumin, and 6MWD. We propose here that TTR may be considered as one of the clinical parameters for the assessment of frailty, although further study is needed.…”

Section: Discussionmentioning

confidence: 99%

Nutrition‐related factors associated with waiting list mortality in patients with interstitial lung disease: A retrospective cohort study

Oshima

Nishimura

Chen‐Yoshikawa

et al. 2019

Clinical Transplantation

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Japanese patients with interstitial lung disease (ILD) sometimes die waiting for lung transplantation (LTx) because it takes about 2 years to receive it in Japan. We evaluated nutrition‐related factors associated with waiting list mortality. Seventy‐six ILD patients were hospitalized in Kyoto University Hospital at registration for LTx from 2013 to 2015. Among them, 40 patients were included and analyzed. Patient background was as follows: female, 30%; age, 50.3 ± 6.9 years; body mass index, 21.1 ± 4.0 kg/m2; 6‐minute walk distance (6MWD), 356 ± 172 m; serum albumin, 3.8 ± 0.4 g/dL; serum transthyretin (TTR), 25.3 ± 7.5 mg/dL; and C‐reactive protein, 0.5 ± 0.5 mg/dL. Median observational period was 497 (range 97‐1015) days, and median survival time was 550 (95% CI 414‐686) days. Survival rate was 47.5%, and mortality rate was 38.7/100 person‐years. Cox analyses showed that TTR (HR 0.791, 95% CI 0.633‐0.988) and 6MWD (HR 0.795, 95% CI 0.674‐0.938) were independently correlated with mortality and were influenced by body fat mass and leg skeletal muscle mass, respectively. It is suggested that nutritional markers and exercise capacity are important prognostic markers in waitlisted patients, but further study is needed to determine whether nutritional intervention or exercise can change outcomes.

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“…The trend of hand-grip strength was followed with actual and %predicted values [ 14 ]. The low physical performance was determined by 6-min walk distance (6MWD) with a threshold < 46.5% of predicted distance [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

Recovery of physical function in lung transplant recipients with sarcopenia

et al. 2021

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Background Lung transplant (LTX) can provide a survival benefit and improve physical function for selected patients with advanced pulmonary disease. Sarcopenia is a systemic muscle-failure that can be found in a variety of life stages and disabilities. In this study, we follow the evolution of each variable defined in sarcopenia and the outcomes in LTX recipients with post-transplant sarcopenia. Methods Patients who underwent LTX at Tohoku University Hospital between 2013 and 2018 were consecutively included in the retrospective cohort study, with follow-up to 2019. Sarcopenia was defined by low muscle mass (the cross-sectional area (CSA) of erector spinae muscle (ESM) in thoracic CT with a threshold < 17.24 cm2/m2) and either low muscle strength (hand-grip with a threshold of < 26 kg in males and of < 18 kg in females) or physical performance (6-min walk distance with a threshold < 46.5% of predicted distance). Results Fifty-five recipients were included into the study, of whom 19 patients were defined as sarcopenic and 36 as non-sarcopenic. The muscle mass improved after transplant in both sarcopenic and non-sarcopenic individuals: the median ESM-CSA enlarged from 17.25 cm2/m2 in 2 months post-LTX to 18.55 cm2/m2 in 12 months (p < 0.001) and 17.63 cm2/m2 in 36 months (p < 0.001) in non-sarcopenic individuals, while in sarcopenic patients it improved from 13.36 cm2/m2 in 2 months to 16.31 cm2/m2 in 12 months (p < 0.005) and 18.01 cm2/m2 in 36 months (p < 0.001). The muscle mass in sarcopenia substantially recovered to close to non-sarcopenic conditions within 36-months (p < 0.001 in 2 months and p = 0.951 in 36 months). Accordingly, muscle strength and physical performance in both groups improved over time. No difference in survival was seen in both groups (Log-rank p = 0.096), and sarcopenia was not associated with an overall hazard of death (p = 0.147). There was no difference in the cumulative incidence of chronic lung allograft dysfunction between patients with or without sarcopenia (Log-rank p = 0.529). Conclusions Even patients with post-transplant sarcopenia have a chance to recover physical function to levels close to those without sarcopenia several years post LTX.

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Frailty and clinical benefits with lung transplantation

Cited by 55 publications

References 67 publications

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

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

Nutrition‐related factors associated with waiting list mortality in patients with interstitial lung disease: A retrospective cohort study

Recovery of physical function in lung transplant recipients with sarcopenia

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