ORIGINAL ARTICLE
Frailty phenotypes and mortality after lung transplantation: A prospective cohort study

https://doi.org/10.1111/ajt.14873Get rights and content
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Frailty is associated with increased mortality among lung transplant candidates. We sought to determine the association between frailty, as measured by the Short Physical Performance Battery (SPPB), and mortality after lung transplantation. In a multicenter prospective cohort study of adults who underwent lung transplantation, preoperative frailty was assessed with the SPPB (n = 318) and, in a secondary analysis, the Fried Frailty Phenotype (FFP; n = 299). We tested the association between preoperative frailty and mortality following lung transplantation with propensity score–adjusted Cox models. We calculated postestimation marginalized standardized risks for 1-year mortality by frailty status using multivariate logistic regression. SPPB frailty was associated with an increased risk of both 1- and 4-year mortality (adjusted hazard ratio [aHR]: 7.5; 95% confidence interval [CI]: 1.6-36.0 and aHR 3.8; 95%CI: 1.8-8.0, respectively). Each 1-point worsening in SPPB was associated with a 20% increased risk of death (aHR: 1.20; 95%CI: 1.08-1.33). Frail subjects had an absolute increased risk of death within the first year after transplantation of 12.2% (95%CI: 3.1%-21%). In secondary analyses, FFP frailty was associated with increased risk of death within the first postoperative year (aHR: 3.8; 95%CI: 1.1-13.2) but not over longer follow-up. Preoperative frailty is associated with an increased risk of death after lung transplantation.

KEYWORDS

clinical research/practice
lung transplantation/pulmonology
patient survival
recipient selection

Abbreviations

6MWD
6-minute walk distance
BMI
body mass index
CRP
C-reactive protein
CUMC
Columbia University Medical Center
DASI
Duke activity status index questionnaire
FFP
Fried frailty phenotype
FFP-DASI
Fried frailty phenotype utilizing the Duke Activity Status Index questionnaire as the measure of low activity
FFP-MLTA
Fried frailty phenotype utilizing the Minnesota Leisure Time Activity questionnaire as the measure of low activity
FVC
forced vital capacity
IL-6
interleukin-6
LAS
lung allocation score
LTBC
lung transplant body composition
MLTA
Minnesota leisure time activity questionnaire
SPPB
short physical performance battery
SPRINTT
sarcopenia and physical frailty in older people: multicomponent treatment strategies Consortium
TNF
tumor necrosis factor
UCSF
University of California, San Francisco

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