Frailty Is Associated With Pre-Operative Delisting and Death in Lung Transplant Candidates

Singer, Jonathan P.; Diamond, Joshua M.; Gries, Cynthia J.; McDonnough, J.; Blanc, Paul D.; Shah, Rupal J.; Dean, M.Y.; Hersch, B.; Dolan, Joseph G.; Arcasoy, Selim M.; Greenland, John R.; Smith, N.; Patterson, Stephen; Shah, Lori; Golden, Jeffrey A.; Blumenthal, Nancy P.; Sonett, Joshua R.; Hays, Steven R.; Oyster, Michelle; D’Ovidio, Frank; Katz, Patricia P.; Robbins, Hilary; Brown, Melanie; Kukreja, Jasleen; Bacchetta, Matthew; Rushefski, Melanie; Raza, K.; Christie, Jason D.; Lederer, DJ

doi:10.1016/j.healun.2015.01.028

Cited by 3 publications

(2 citation statements)

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“…We hypothesized that frailty would be common and independently associated with disability and an increased risk of death or delisting in lung transplant candidates. Some of the results of this study have been reported previously in the form of abstracts (18)(19)(20)(21)(22)(23)(24).…”

supporting

confidence: 54%

Frailty Phenotypes, Disability, and Outcomes in Adult Candidates for Lung Transplantation

Singer¹,

Diamond²,

Gries

et al. 2015

Am J Respir Crit Care Med

188

216

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Rationale: Frailty is associated with morbidity and mortality in abdominal organ transplantation but has not been examined in lung transplantation.Objectives: To examine the construct and predictive validity of frailty phenotypes in lung transplant candidates.Methods: In a multicenter prospective cohort, we measured frailty with the Fried Frailty Phenotype (FFP) and Short Physical Performance Battery (SPPB). We evaluated construct validity through comparisons with conceptually related factors. In a nested case-control study of frail and nonfrail subjects, we measured serum IL-6, tumor necrosis factor receptor 1, insulin-like growth factor I, and leptin. We estimated the association between frailty and disability using the Lung Transplant Valued Life Activities disability scale. We estimated the association between frailty and risk of delisting or death before transplant using multivariate logistic and Cox models, respectively.Measurements and Main Results: Of 395 subjects, 354 completed FFP assessments and 262 completed SPPB assessments; 28% were frail by FFP (95% confidence interval [CI], 24-33%) and 10% based on the SPPB (95% CI, 7-14%). By either measure, frailty correlated more strongly with exercise capacity and grip strength than with lung function. Frail subjects tended to have higher plasma IL-6 and tumor necrosis factor receptor 1 and lower insulin-like growth factor I and leptin. Frailty by either measure was associated with greater disability. After adjusting for age, sex, diagnosis, and transplant center, both FFP and SPPB were associated with increased risk of delisting or death before lung transplant. For every 1-point worsening in score, hazard ratios were 1.30 (95% CI, 1.01-1.67) for FFP and 1.53 (95% CI, 1.19-1.59) for SPPB.Conclusions: Frailty is prevalent among lung transplant candidates and is independently associated with greater disability and an increased risk of delisting or death.Keywords: biomarker; body composition; disability; frailty; lung transplantation Author Contributions: J.P.S., J.M.D., C.J.G., P.D.B., P.P.K., J.D.C., and D.J.L. made substantial contributions to the conception and design of the work; J.P.S. wrote the first draft of the manuscript; and J.P.S., J

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supporting

confidence: 54%

Frailty Phenotypes, Disability, and Outcomes in Adult Candidates for Lung Transplantation

Singer¹,

Diamond²,

Gries

et al. 2015

Am J Respir Crit Care Med

188

216

View full text Add to dashboard Cite

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“…66 This drives overall charges up further, with each day estimated at an additional $20 000. 20,23,67,68 The accompanying debilitation and need for intensive postoperative and postdischarge rehabilitation further compounds the demand and use of resources for these frail patients. 2,16,23 The training and use of specialized personnel (perfusionists, occupational therapists, and physical therapists), the need for additional procedures such as tracheostomy, vascular interventions, enteral access, and the increased likelihood of complications, each further contribute to higher cost.…”

Section: Influence Of Volumementioning

confidence: 99%

Extracorporeal Membrane Oxygenation in the Perioperative Care of the Lung Transplant Patient

Hayanga

Chan

Musgrove

et al. 2020

Semin Cardiothorac Vasc Anesth

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Lung transplantation (LT) is definitive therapy for end-stage lung disease. Donor allocation based on medical urgency has led to an increased trend in the transplantation of sicker and older patients. Mechanical ventilation (MV) formerly was the only method of bridging high-acuity patients to LT. When the physiological demands of ventilatory support exceeds the capability of MV, extracorporeal membrane oxygenation (ECMO) may become necessary. Recent improvements in ECMO technology and component design have led to a resurgence of interest in its use before, during, and after LT. Survival with ECMO as a bridge to LT has improved over time, now with many centers reporting little or no difference in outcomes, and some even reporting better outcomes, as compared with MV. Extracorporeal life support may also be used intraoperatively. In many studies to date, ECMO or cardiopulmonary bypass (CPB) has been reserved for patients who became hemodynamically unstable during the procedure or patients who could not tolerate single-lung ventilation. Both methods of support are fraught with potential complications. However, multiple studies comparing ECMO with CPB have shown that intraoperative use of ECMO resulted in improved outcomes and overall survival as well as lower rates of bleeding complications. In order to further reduce complications associated with ECMO, planned intraoperative ECMO use is occasionally reserved for high-risk patients who might otherwise require CPB. Future studies will need to improve patient selection to fully take advantage of the use of ECMO in LT while minimizing its costs.

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Indications and Contraindications in Lung Transplantation

Slama

Aigner

2020

Thoracic Surgery

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Frailty Is Associated With Pre-Operative Delisting and Death in Lung Transplant Candidates

Cited by 3 publications

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Frailty Phenotypes, Disability, and Outcomes in Adult Candidates for Lung Transplantation

Frailty Phenotypes, Disability, and Outcomes in Adult Candidates for Lung Transplantation

Extracorporeal Membrane Oxygenation in the Perioperative Care of the Lung Transplant Patient

Indications and Contraindications in Lung Transplantation

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