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• W2895571622 abstract "SESSION TITLE: Advances in the Evaluation of Lung Transplant Patients SESSION TYPE: Original Investigations PRESENTED ON: 10/09/2018 08:45 AM - 09:45 AM PURPOSE: Current guidelines for lung transplant candidate selection emphasize measures of pulmonary disease, however, measures of frailty have recently been associated with pre-transplant delisting or death as well as shorter post-transplant survival in a limited cohort. This highlights the potential role of frailty assessment in refining candidate selection and identifying modifiable risk factors. The generalizability of existing frailty assessment instruments to the lung transplant population is unclear as none have been specifically designed to consider the unique characteristics and vulnerabilities of this population. METHODS: We analyzed our single center experience assessing frailty with the Transplant Cumulative Deficits Frailty Index (TFI), a 40-item questionnaire that measured multiple health domains based on clinical candidacy assessment data. We hypothesized that higher TFI (more comorbidities and limitations) would correspond to greater declines in six-minute walk distance (6MWD) with transplant and smaller improvements in walk distance after post-transplant pulmonary rehabilitation. RESULTS: In the study cohort of 135 patients who subsequently had a transplant, TFI was normally distributed (mean 0.35, range 0.18-0.6). Native lung disease reflected our center's population: 49% restrictive, 25% obstructive, 21% cystic fibrosis/septic lung (CF) and 5% vascular. The CF subgroup (n=28) and vascular disease (n=7) had a significantly higher TFI compared to the restrictive disease subgroup (p<0.0001). Higher TFI was associated with a younger age (p<0.001), likely reflecting the CF subgroup. Lower TFI was associated with higher pre-transplant 6MWD (p=0.03). While pre-transplant 6MWD was highly associated with the change in 6MWD with transplant (p<0.0001), TFI was not associated with 6MWD decline related to transplant or improvement in 6MWD with post-transplant rehabilitation. CONCLUSIONS: Lung transplant candidates have a range of TFI, suggesting the instrument provides a different assessment than just advanced pulmonary disease. While the TFI was associated with native lung disease and 6MWD prior to transplant, it did not correlate to changes in 6MWD with transplant or with rehabilitation. CLINICAL IMPLICATIONS: We anticipate that TFI can provide information that enhances candidate selection and identify patients whose frailty-related risk can be reduced with additional intervention. This effect will be further defined as TFI is applied to a larger cohort and compared with additional outcomes. Given the higher score and broader range seen in CF candidates, it may prove a particularly useful tool to assess this subset of candidates. DISCLOSURES: No relevant relationships by Pali Dedhiya, source=Web Response Consultant relationship with Boehringer Ingelheim Please note: $1001 - $5000 Added 02/28/2018 by Lianne Singer, source=Web Response, value=Consulting fee No relevant relationships Added 02/28/2018 by Laurie Snyder, source=Web Response, value=Consulting fee Removed 02/28/2018 by Laurie Snyder, source=Web Response No relevant relationships Added 02/28/2018 by Laurie Snyder, source=Web Response, value=Consulting fee Removed 02/28/2018 by Laurie Snyder, source=Web Response No relevant relationships by Daniel Turner, source=Web Response" @default.
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• W2895571622 date "2018-10-01" @default.
• W2895571622 modified "2023-09-25" @default.
• W2895571622 title "USE OF A NOVEL CUMULATIVE DEFICITS FRAILTY INSTRUMENT IN LUNG TRANSPLANT CANDIDATES" @default.
• W2895571622 doi "https://doi.org/10.1016/j.chest.2018.08.1000" @default.
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