The following is a summary of “Evaluation of Frailty Measures and Short-term Outcomes After Lung Transplantation,” published in the July 2023 issue of the Chest by  Swaminathan et al.

Before and after lung transplantation, frailty, measured as a singular construct, is associated with variable poor outcomes. Unknown is the utility of a comprehensive frailty assessment before transplantation. How do multiple frailty constructs, such as phenotypic and cumulative deficit models, muscle mass, exercise tolerance, and social vulnerabilities measured before lung transplantation, relate to short-term outcomes? The researchers conducted a retrospective cohort study of 515 lung transplant recipients who underwent frailty assessments before transplantation, including the short physical performance battery (SPPB), transplant-specific frailty index (FI), 6-minute walk distance (6MWD), thoracic sarcopenia, and social vulnerability index. 

Using logistic regression to model 1-year survival and zero-inflated negative binomial regression to model hospital-free days (HFDs) in the first 90 days after transplantation, they examined the relationship between pre-transplant frailty measures and post-transplant outcomes. Age, gender, native lung disease, transplantation type, lung allocation score, body mass index, and primary graft dysfunction were adjusted covariates. Before transplantation, 51.3% of patients were frail as measured by FI (FI 0.25), but none were fragile as measured by SPPB. Greater frailty by FI, but not SPPB, was associated with fewer HFDs (–0.006 per 0.01 unit worsening; 95% CI, –0.01 to –0.002 per 0.01 unit worsening) among discharged patients in multivariate-adjusted models that also included FI, SPPB, and 6MWD. 

More significant SPPB deficits were associated with reduced 1-year survival odds (OR, 0.51 per 1 unit worsening; 95% CI, 0.28-0.93 per 1 unit worsening). Overall, the correlation between frailty measurements was inadequate. There was no correlation between thoracic sarcopenia, the 6-minute walk distance, social vulnerability assessments, and short-term outcomes after lung transplantation. Both phenotypic and cumulative deficit models measured before lung transplantation are correlated with short-term outcomes. Incremental deficit measures of frailty may be more pertinent in the first 90 days after transplantation, whereas phenotypic defect may be more strongly associated with one-year survival.

Source: sciencedirect.com/science/article/abs/pii/S0012369223001216