Assessing Levels of Frailty in a Cohort of Lung Transplant Candidates Using Pre-Transplant Frailty Assessments

Abstract

Purpose Frailty, a syndrome of fatigue, muscle wasting and weakness, has been shown to associate with adverse outcomes after surgery in many patients, and its importance in the lung transplant population was described by Singer and colleagues. This study explores the prevalence of frailty among lung transplant candidates using two standard frailty measures and their relationship with the lung allocation score (LAS). Methods In a single-center prospective study, frailty was assessed in lung transplant candidates ≥60 years of age using Fried's Frailty Phenotype (FFP) and the Short Physical Performance Battery (SPPB). The FFP score is based on self-reported weight loss, fatigue, physical activity, and measures of gait speed and grip strength. The SPPB score consists of measures of gait speed, balance, and lower extremity strength. Previously established cutoffs were used: FFP score of 0 = non-frail; 1-2 = pre-frail; 3-5 = frail; SPPB score of 0-6 = frail; 7-9 = pre-frail; 10-12 = non-frail. The LAS score was calculated from clinical and imaging data obtained during transplant candidacy evaluation. Results Out of 32 subjects, 26 completed both the SPPB and FFP assessments, while 6 completed only the SPPB assessment. The average SPPB and FFP scores were 8.4 (±2.7) and 2.8 (±1.2), respectively. SPPB and FFP were only weakly correlated with adjusted r2 0.133 (p = 0.038). The average LAS score was 43.8 (±14.3). Both the SPPB (r2 = 0.41, p Conclusion In lung transplant candidates, the prevalence of frailty considerably varies based upon which frailty assessment tool is utilized. Compared to the FFP score, the SPPB score has a stronger correlation with the LAS. A better understanding of the relationship between frailty measures and risk predictors such as the LAS will help to improve pre-transplant risk assessment protocols, identify vulnerable patients, and target interventions to optimize outcomes. Patient enrollment is ongoing at our center.