Pretransplant frailty is associated with decreased survival after lung transplantation

doi:10.1016/j.healun.2015.10.014

The Journal of Heart and Lung Transplantation

Volume 35, Issue 2, February 2016, Pages 173-178

https://doi.org/10.1016/j.healun.2015.10.014 Get rights and content

Background

Frailty is a condition of increased vulnerability to adverse health outcomes. Although frailty is an important prognostic factor for many conditions, the effect of frailty on mortality in lung transplantation is unknown. Our objective was to assess the association of frailty with survival after lung transplantation.

Methods

We performed a retrospective cohort analysis of all adult lung transplant recipients at our institution between 2002 and 2013. Frailty was assessed using the frailty deficit index, a validated instrument that assesses cumulative deficits for up to 32 impairments and measures the proportion of deficits present (with frailty defined as >0.25). We examined the association between frailty and survival, adjusting for age, sex, and bilateral (vs single) lung transplant using Cox proportional hazard regression models.

Results

Among 144 lung transplant patients, 102 (71%) completed self-reported questionnaires necessary to assess the frailty deficit index within 1 year before lung transplantation. Frail patients (n = 46) had an increased risk of death, with an adjusted hazard ratio (HR) of 2.24 (95% confidence interval [CI], 1.22–4.19; p = 0.0089). Frailty was not associated with an increased duration of mechanical ventilation (median, 2 vs 2 days; p = 0.26), intensive care unit length of stay (median, 7.5 vs 6 days; p = 0.36) or hospital length of stay after transplantation (median, 14 vs 10.5 days; p = 0.26).

Conclusions

Pre-transplant frailty was independently associated with decreased survival after lung transplantation. Pre-transplant frailty may represent an important area for intervention to improve candidate selection and lung transplant outcomes.

Section snippets

Patient population

All adults undergoing single or bilateral lung transplantation at Mayo Clinic, Rochester, Minnesota, from January 1, 2002, to December 31, 2013, were eligible for study inclusion. Heart-lung transplant or retransplant patients were excluded. The Mayo Clinic Institutional Board of Review approved the study protocol (IRB #150000767).

Definition of frailty

Frailty was defined using a validated frailty deficit index measurement tool, with a score of 0.25 or greater defined as “frail,” as previously described by Rockwood

Population

Of 144 patients who underwent lung transplantation from January 1, 2002, to December 31, 2013. 102 (71%) completed the questionnaires necessary to calculate the frailty deficit index and were included in the analysis (Table 1). Self-reported questionnaires were completed independently by patients 90% of the time and with the assistance of a family member 10% of the time. Inter-rater agreement for record abstraction was excellent (κ = 0.8). Patients were a median age of 57 years (IQR, 51–62.3

Discussion

Our study demonstrates an association between frailty and survival after lung transplantation. Patients who were frail before lung transplantation had an increased risk of death that persisted after adjustment for age, sex, and bilateral lung transplantation. In addition, our study describes the prevalence of frailty in a lung transplant population. We found that the prevalence of frailty was high at 45.1% (46 of 102), which is notable, given that lung transplant patients are a carefully

Disclosure statement

None of the authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.

This work was supported by the Mayo Clinic Department of Medicine Research Career Development Award (C.C.K). S.M.D. is supported by National Institutes of Health grant K23-HL1-16643.

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View full text

Pretransplant frailty is associated with decreased survival after lung transplantation

Background

Methods

Results

Conclusions

Section snippets

Patient population

Definition of frailty

Population

Discussion

Disclosure statement

J Heart Lung Transplant

J Heart Lung Transplant

Am Heart J

Heart Lung

Am J Transplant

J Heart Lung Transplant

J Heart Lung Transpl

J Heart Lung Transplant

J Heart Lung Transplant

J Heart Lung Transplant

Am J Transplant

J Heart Lung Transplant

Transplant Proc

Lung donor selection and management

Proc Am Thorac Soc

Transplantation 50 years later—progress, challenges, and promises

N Engl J Med

A global clinical measure of fitness and frailty in elderly people

Cmaj

A comparison of two approaches to measuring frailty in elderly people

J Gerontol A Biol Sci Med Sci

Accumulation of deficits as a proxy measure of aging

ScientificWorldJournal