Frailty and Survival After Lung Transplant

Abstract

SESSION TITLE: Lung Transplantation SESSION TYPE: Original Investigation Slide PRESENTED ON: Wednesday, October 28, 2015 at 04:30 PM - 05:30 PM PURPOSE: Frailty is characterized by the loss of physiologic and cognitive reserves that gives rise to increased vulnerability to adverse outcomes. While frailty has been shown to be an important prognostic factor for many conditions, its study in lung transplantation is novel. Our objective was to assess the association of frailty with outcomes in lung transplantation. METHODS: We retrospectively reviewed all patients who underwent lung transplantation from 2002-2013 at Mayo Clinic in Rochester, Minnesota. Frailty was assessed using the frailty deficit index, a validated measurement of frailty that measures the proportion of deficits present among 32 impairments, disabilities, and comorbidities. The sample was divided at the median into two equally sized groups based on deficit index (deficit index ≥0.22 = frail and <0.22 = not frail). We examined the association between frailty and survival using Cox proportional hazard regression models. The median follow-up was 4.9 years and patients were censored after 5 years of follow-up or last follow-up through December 2014. RESULTS: Among 144 lung transplant patients, 102 (71%) completed self-reported questionnaires necessary to assess the deficit index. Patients who were frail were at an increased risk of death (HR 2.14, 95% CI 1.14 to 4.11, p value=0.018) compared to those who were not frail. This trend persisted when adjusted for age and gender. The frailty deficit index showed a stronger association with mortality than did low body mass index at transplant and slow gait speed. Frailty was associated with a non-statistically significant trend towards increased hospital length of stay after transplantation (17.8 days versus 14.8 days, p=0.32). CONCLUSIONS: Frailty was associated with decreased survival after lung transplantation. CLINICAL IMPLICATIONS: Assessing frailty may improve prognostication, informed decision making, and patient selection for lung transplantation. It may also identify a cohort of vulnerable patients who may benefit from specialized intervention. DISCLOSURE: The following authors have nothing to disclose: Michael Wilson, Abhay Vakil, Pujan Kandel, Chaitanya Undavalli, Shannon Dunlay, Cassie Kennedy No Product/Research Disclosure Information