Frailty phenotypes and mortality after lung transplantation: A prospective cohort study

Abstract

Frailty is associated with increased mortality among lung transplant candidates. We sought to determine the association between frailty, as measured by the Short Physical Performance Battery (SPPB), and mortality after lung transplantation. In a multicenter prospective cohort study of adults who underwent lung transplantation, preoperative frailty was assessed with the SPPB (n = 318) and, in a secondary analysis, the Fried Frailty Phenotype (FFP; n = 299). We tested the association between preoperative frailty and mortality following lung transplantation with propensity score-adjusted Cox models. We calculated postestimation marginalized standardized risks for 1-year mortality by frailty status using multivariate logistic regression. SPPB frailty was associated with an increased risk of both 1- and 4-year mortality (adjusted hazard ratio [aHR]: 7.5; 95% confidence interval [CI]: 1.6-36.0 and aHR 3.8; 95%CI: 1.8-8.0, respectively). Each 1-point worsening in SPPB was associated with a 20% increased risk of death (aHR: 1.20; 95%CI: 1.08-1.33). Frail subjects had an absolute increased risk of death within the first year after transplantation of 12.2% (95%CI: 3.1%-21%). In secondary analyses, FFP frailty was associated with increased risk of death within the first postoperative year (aHR: 3.8; 95%CI: 1.1-13.2) but not over longer follow-up. Preoperative frailty is associated with an increased risk of death after lung transplantation.

A mobile health technology enabled home‐based intervention to treat frailty in adult lung transplant candidates: A pilot study

“…Each component is scored from 0 to 4, yielding an aggregate score ranging from 0 to 12. Lower SPPB scores reflect increased frailty, and a threshold ≤7 has been used in lung transplantation to define the frail state . Other studies have used different thresholds to define frailty by SPPB (eg, 6, 8, 9, 10), and prior work in COPD used a threshold of ≤9 .…”

“…Frailty, originally a geriatric construct, reflects accumulated deficits across physiologic systems that attenuate the body's physiologic reserve. We recently demonstrated that frailty is prevalent in lung transplant candidates and is independently associated with disability and delisting or death on the waiting list, as well as with death after lung transplantation . Recent studies in community‐dwelling and institutionalized older adults suggest that frailty may be reversible through exercise‐based intervention .…”

“…We recently demonstrated that frailty is prevalent in lung transplant candidates and is independently associated with disability and delisting or death on the waiting list, as well as with death after lung transplantation. 6,7 Recent studies in community-dwelling and institutionalized older adults suggest that frailty may be reversible through exercise-based intervention. [8][9][10][11] For those with lung disease, traditional hospital-based pulmonary rehabilitation may achieve similar goals, but many patients cannot access these programs due to geography or insurance limitations.…”

Report from the American Society of Transplantation on frailty in solid organ transplantation

“…Most screening tools for frailty are based on two concepts: "physical" or "phenotypic" frailty, versus "deficit accumulation" or "index" frailty. [22][23][24][25][26] Low muscle mass and function (known as sarcopenia) has also been used as an objective indicator of frailty and can be reliably measured by dual-energy X-ray absorptiometry (DEXA), or estimated by computed tomography (CT), magnetic resonance imaging, or bioimpedance. The testing takes under 10 minutes to administer, is easily implemented, and can be interpreted by nongeriatricians.…”

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

“…The subjects of this study had an average BMI of 21.1, but skeletal muscle mass was decreased to 84.1% and body fat mass was increased to 151.8%. 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. Therefore, in nonobese waitlisted ILD patients, reducing body fat mass by nutritional intervention cannot be recommended because it may instead decrease TTR and albumin and possibly promote sarcopenia, 30,31 which results in poor prognosis.…”