Evaluation of Frailty Measures and Short-term Outcomes After Lung Transplantation.

BACKGROUND: Frailty, measured as a single construct, is associated variably with poor outcomes before and after lung transplantation. The usefulness of a comprehensive frailty assessment before transplantation is unknown. RESEARCH QUESTION: How are multiple frailty constructs, including phenotypic and cumulative deficit models, muscle mass, exercise tolerance, and social vulnerabilities, measured before transplantation, associated with short-term outcomes after lung transplantation? STUDY DESIGN AND METHODS: We conducted a retrospective cohort study of 515 lung recipients who underwent frailty assessments before transplantation, including the short physical performance battery (SPPB), transplant-specific frailty index (FI), 6-min walk distance (6MWD), thoracic sarcopenia, and social vulnerability indexes. We tested the association between frailty measures before transplantation and outcomes after transplantation using logistic regression to model 1-year survival and zero-inflated negative binomial regression to model hospital-free days (HFDs) in the first 90 days after transplantation. Adjustment covariates included age, sex, native lung disease, transplantation type, lung allocation score, BMI, and primary graft dysfunction. RESULTS: Before transplantation, 51.3% of patients were frail by FI (FI ≥ 0.25) and no patients were frail by SPPB. In multivariate adjusted models that also included FI, SPPB, and 6MWD, greater frailty by FI, but not SPPB, was associated with fewer HFDs (-0.006 per 0.01 unit worsening; 95% CI, -0.01 to -0.002 per 0.01 unit worsening) among discharged patients. Greater SPPB deficits were associated with decreased odds of 1-year survival (OR, 0.51 per 1 unit worsening; 95% CI, 0.28-0.93 per 1 unit worsening). Correlation among frailty measurements overall was poor. No association was found between thoracic sarcopenia, 6MWD, or social vulnerability assessments and short-term outcomes after lung transplantation. INTERPRETATION: Both phenotypic and cumulative deficit models measured before transplantation are associated with short-term outcomes after lung transplantation. Cumulative deficit measures of frailty may be more relevant in the first 90 days after transplantation, whereas phenotypic frailty may have a stronger association with 1-year survival.

Pretransplant physical frailty, postoperative delirium, and short-term outcomes among older lung transplant recipients.

PURPOSE: Delirium is a common, complex medical challenge that faces surgical patients in the postoperative period. Patients undergoing lung transplantation are at especially high risk given their predisposition to physical frailty and prolonged hospitalization. We sought to investigate the relationship between physical frailty, delirium, and short-term lung transplantation outcomes. MATERIALS AND METHODS: A retrospective study of adult patients who underwent lung transplantation was conducted. Pretransplant frailty markers, including the six-minute walk distance (6MWD) and short physical performance battery (SPPB), and postoperative outcomes, including the incidence of primary graft dysfunction (PGD) and the number of hospital free days alive in the 90-day interval following lung transplantation, were evaluated for association with delirium. RESULTS: A total of 100 patients were included, 38% of whom experienced delirium. Greater pretransplant SPPB scores (indicating lower physical frailty) associated with a lower incidence of postoperative delirium. Postoperative delirium also associated with the number of hospital free days alive, independent of PGD. CONCLUSION: Pretransplant frailty is associated with greater incidence of postoperative delirium, which associated with fewer days alive outside of the hospital. Targeting frailty and postoperative delirium may be modifiable risk factors to improve short-term clinical outcomes.