Michael E Wilson1, Abhay P Vakil1, Pujan Kandel1, Chaitanya Undavalli1, Shannon M Dunlay2, Cassie C Kennedy3. 1. Division of Pulmonary and Critical Care Medicine. 2. Division of Cardiovascular Diseases; Department of Health Sciences Research; William J. von Liebig Mayo Transplant Center, Mayo Clinic, Rochester, Minnesota. 3. Division of Pulmonary and Critical Care Medicine; William J. von Liebig Mayo Transplant Center, Mayo Clinic, Rochester, Minnesota. Electronic address: kennedy.cassie@mayo.edu.
Abstract
BACKGROUND: Frailty is a condition of increased vulnerability to adverse health outcomes. Although frailty is an important prognostic factor for many conditions, the effect of frailty on mortality in lung transplantation is unknown. Our objective was to assess the association of frailty with survival after lung transplantation. METHODS: We performed a retrospective cohort analysis of all adult lung transplant recipients at our institution between 2002 and 2013. Frailty was assessed using the frailty deficit index, a validated instrument that assesses cumulative deficits for up to 32 impairments and measures the proportion of deficits present (with frailty defined as >0.25). We examined the association between frailty and survival, adjusting for age, sex, and bilateral (vs single) lung transplant using Cox proportional hazard regression models. RESULTS: Among 144 lung transplant patients, 102 (71%) completed self-reported questionnaires necessary to assess the frailty deficit index within 1 year before lung transplantation. Frail patients (n = 46) had an increased risk of death, with an adjusted hazard ratio (HR) of 2.24 (95% confidence interval [CI], 1.22-4.19; p = 0.0089). Frailty was not associated with an increased duration of mechanical ventilation (median, 2 vs 2 days; p = 0.26), intensive care unit length of stay (median, 7.5 vs 6 days; p = 0.36) or hospital length of stay after transplantation (median, 14 vs 10.5 days; p = 0.26). CONCLUSIONS: Pre-transplant frailty was independently associated with decreased survival after lung transplantation. Pre-transplant frailty may represent an important area for intervention to improve candidate selection and lung transplant outcomes.
BACKGROUND: Frailty is a condition of increased vulnerability to adverse health outcomes. Although frailty is an important prognostic factor for many conditions, the effect of frailty on mortality in lung transplantation is unknown. Our objective was to assess the association of frailty with survival after lung transplantation. METHODS: We performed a retrospective cohort analysis of all adult lung transplant recipients at our institution between 2002 and 2013. Frailty was assessed using the frailty deficit index, a validated instrument that assesses cumulative deficits for up to 32 impairments and measures the proportion of deficits present (with frailty defined as >0.25). We examined the association between frailty and survival, adjusting for age, sex, and bilateral (vs single) lung transplant using Cox proportional hazard regression models. RESULTS: Among 144 lung transplant patients, 102 (71%) completed self-reported questionnaires necessary to assess the frailty deficit index within 1 year before lung transplantation. Frail patients (n = 46) had an increased risk of death, with an adjusted hazard ratio (HR) of 2.24 (95% confidence interval [CI], 1.22-4.19; p = 0.0089). Frailty was not associated with an increased duration of mechanical ventilation (median, 2 vs 2 days; p = 0.26), intensive care unit length of stay (median, 7.5 vs 6 days; p = 0.36) or hospital length of stay after transplantation (median, 14 vs 10.5 days; p = 0.26). CONCLUSIONS: Pre-transplant frailty was independently associated with decreased survival after lung transplantation. Pre-transplant frailty may represent an important area for intervention to improve candidate selection and lung transplant outcomes.
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Authors: Jonathan P Singer; Joshua M Diamond; Michaela R Anderson; Patricia P Katz; Ken Covinsky; Michelle Oyster; Tatiana Blue; Allison Soong; Laurel Kalman; Pavan Shrestha; Selim M Arcasoy; John R Greenland; Lori Shah; Jasleen Kukreja; Nancy P Blumenthal; Imaani Easthausen; Jeffrey A Golden; Amika McBurnie; Ed Cantu; Joshua Sonett; Steven Hays; Hilary Robbins; Kashif Raza; Matthew Bacchetta; Rupal J Shah; Frank D'Ovidio; Aida Venado; Jason D Christie; David J Lederer Journal: Am J Transplant Date: 2018-05-14 Impact factor: 8.086