title: Pretransplant frailty is associated with decreased survival after lung transplantation.
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.
authors.affiliation: Division of Pulmonary and Critical Care Medicine.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Wilson
authors.affiliation: Division of Pulmonary and Critical Care Medicine.
authors.forename: Abhay P
authors.initials: AP
authors.lastname: Vakil
authors.affiliation: Division of Pulmonary and Critical Care Medicine.
authors.forename: Pujan
authors.initials: P
authors.lastname: Kandel
authors.affiliation: Division of Pulmonary and Critical Care Medicine.
authors.forename: Chaitanya
authors.initials: C
authors.lastname: Undavalli
authors.affiliation: Division of Cardiovascular Diseases; Department of Health Sciences Research; William J. von Liebig Mayo Transplant Center, Mayo Clinic, Rochester, Minnesota.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Dunlay
authors.affiliation: Division of Pulmonary and Critical Care Medicine; William J. von Liebig Mayo Transplant Center, Mayo Clinic, Rochester, Minnesota. Electronic address: kennedy.cassie@mayo.edu.
authors.forename: Cassie C
authors.initials: CC
authors.lastname: Kennedy
mesh_terms: D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
keywords: adults; frailty; frailty deficit index; health outcomes; lung transplant; pre-transplant; survival