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Frailty trajectories in adult lung transplantation: A cohort study

https://doi.org/10.1016/j.healun.2019.03.006Get rights and content

BACKGROUND

Frailty is common in adults with advanced lung disease and is associated with death before and after lung transplantation. We aimed to determine whether frailty changes from before to after the lung transplant.

METHODS

In a single-center, prospective cohort study among adults undergoing lung transplantation from 2010 to 2017, we assessed frailty by the Short Physical Performance Battery (SPPB; higher scores reflect less frailty) and Fried Frailty Phenotype (FFP; higher scores reflect greater frailty) before and repeatedly up to 36 months after transplant. We tested for changes in frailty scores over time using segmented mixed effects models, adjusting for age, sex, and diagnosis. We quantified the proportion of subjects transitioning between frailty states (frail vs not frail) from before to after the transplant.

RESULTS

In 246 subjects, changes in frailty occurred within the first 6 post-operative months and remained stable thereafter. The overall change in frailty was attributable to improvements among those subjects who were frail before transplant. They experienced a 5.1-point improvement in SPPB (95% confidence interval [CI] 4.6–5.7) and a 1.8-point improvement in FFP (95% CI −2.1 to −1.6) during the early period. Frailty by SPPB and FFP did not change in those who were not frail before transplant. Approximately 84% of survivors who were frail before transplant became not frail after transplant.

CONCLUSIONS

Pre-operative frailty resolves in many patients after lung transplantation. Because a large proportion of frailty may be attributable to advanced lung disease, frailty alone should not be an absolute contraindication to transplantation.

Section snippets

Study design, participants, and setting

We studied participants in the Breathe Again study, a prospective cohort of adults undergoing first-time lung transplantation between 2010 and 2017 at the University of California, San Francisco,12 assessing the impact of lung transplant on functional status, disability, and HRQL. We assessed measures of physical frailty at the time of transplant listing and repeatedly up to three years after transplant on the same days as routinely scheduled clinical visits (at 3, 6, 12, 18, 24, 30, and 36

Results

Among the 276 subjects who underwent lung transplant, 246 (89%) had baseline frailty assessments before transplant and formed the cohort for analysis (244 subjects with SPPB, 162 with FFP, and 160 with both). Fewer subjects had FFP because this measure was introduced two years after study initiation (Table 1 and Figure 1). The mean time from baseline SPPB assessment to transplant was 76 (range 0‒441) days with median of 53 days (interquartile range [IQR] 21‒107 days). The mean time from

Discussion

In this longitudinal cohort study of frailty trajectories in lung transplantation, we found that frailty, defined by both the Short Physical Performance Battery (SPPB) and the Fried Frailty Phenotype (FFP), improved to a clinically meaningful extent early after transplant and remained stable thereafter. Most notably, the majority of subjects who were frail before transplant no longer met frailty criteria by either measure at 6 months after transplantation. Our study suggests that, for the

Disclosure statement

The authors have no conflicts of interest to disclose. We thank all the patients for their participation in this study. This work was supported by grants from the National Heart, Lung and Blood Institute (K23 HL111115 and R01 HL134851 to J.P.S.) and the Clinical Sciences Research & Development Service of the VA Office of Research and Development (career development award IK2CX001034 to J.R.G.).

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