Characteristics of Frailty in Lung Transplant Candidates

Abstract

INTRODUCTION: Lung transplantation is a lifesaving therapy in patients with advanced lung disease. However, frail lung transplant candidates are more likely to be delisted or die on the wait list. There is a need to objectively identify frailty and assess potentially reversible risk factors in potential lung transplant candidates METHODS: METHODS: We prospectively assessed frailty in 43 consecutive lung transplant candidates using the Fried Frailty Phenotype (FFP), Short physical performance battery (SPPB) tools, and the Montreal Cognitive Assessment (MoCA). We determined prevalence and risk factors associated with frailty utilizing multi-variable logistic regression analysis after adjusting for covariates. RESULTS: We evaluated 43 lung transplant candidates. The average age was 60 years, 23 of whom were female. Their primary diagnoses included COPD (20%), ILD (50%), and Other (30%). Of the 43 lung transplant candidates, 34/43 (79%) were frail (9) or pre-frail (25) by the SPPB and 37/43 (86%) were frail (17) or pre-frail (20) by the FFP (p< 0.05). We found a similar prevalence of frailty among the different underlying diagnoses (COPD, ILD, Other) however, COPD patients demonstrated a strong trend for the higher prevalence of frailty. Patients with lower BMI had an increased prevalence of frailty (p<0.05). Patients with lower educational levels had significantly lower MOCA scores (p<0.001). After adjusting for several covariates, there was an association between decreased diffusing capacity (DLCO) and increased frailty by SPPB. CONCLUSION: Frailty is highly prevalent in lung transplant candidates but varies by the frailty tool. Frailty is associated with decreased DLCO. Patients with COPD have a strong trend for a higher prevalence of frailty. Also, lower BMI is associated with increased frailty, and the validity of the MOCA score is questionable in patients with lower educational levels. Further evaluation of risk factors for frailty and mitigation of these risk factors may enhance patient outcomes post lung transplantation. Further evaluation of frailty in larger populations are needed to validate these findings.