(57) - Frailty and Clinical Benefits with Lung Transplantation

Abstract

Fried frailty index (FFI) is a validated measure in lung transplant (LTx) candidates and is associated with pre-tx outcomes, but its association with post-tx outcomes is unknown. FFI contains parameters not readily available to clinicians. Study aims were: 1)To validate two alternate frailty phenotype models in LTx candidates. 2)To assess associations between pre-tx frailty and post-tx exercise capacity (6MWD), quality of life (HRQL) and 1 year mortality. For aim 1, 50 LTx candidates were prospectively evaluated for each of the 5 frailty attributes using the FFI and two clinical models(Table 1). Model 1 was from variables readily available to clinicians and Model 2 was from an existing dataset. Frailty was defined if ≥ 3 of 5 elements were present with agreement assessed using Kappa statistics. Construct validity was assessed using the London Chest Activity of Daily Living (LCADL) and Short-Physical Performance Battery (SPPB). Model 2 was then applied retrospectively to 226 LTx candidates listed from 1/04-6/09 who had both pre-tx rehab and HRQL (St.George’s Respiratory Questionnaire, SGRQ). Post-tx outcomes were compared between frail and non-frail patients using t-tests and regression analysis adjusting for age, sex, and diagnosis. Frailty prevalence was 28-38% among the three indices. Kappa agreement between FFI and alternate models ranged from 0.34-0.41. All three indices were moderately correlated with LCADL (r=0.42-0.60) and SPPB (r=-0.42 to -0.51). Frail candidates had worse Total SGRQ (72 ± 12 vs. 62 ± 13), p < 0.001. At 3-6 months post-LTx, frail candidates had a larger improvement with LTx in Total SGRQ (-47 ± 19 vs. -39 ± 20, p < 0.01) and 6MWD (153 ± 106 vs. 112 ± 104 m, p < 0.01), with differences persisting after adjustment. There was no difference in 1 year mortality (9% vs. 13%, p=0.42). There was good construct validity and fair agreement among the frailty models. Despite significant disability pre-tx, frail LTx candidates demonstrated significant functional and HRQL benefit with transplantation.