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

Abstract

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.

© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons.

Figures

Figure 1. Time to death by Short Physical Performance Battery within the first year after transplant (A) and over four years after transplant (B)

Solid lines = frail, dashed lines = not frail.

Figure 1. Time to death by Short Physical Performance Battery within the first year after transplant (A) and over four years after transplant (B)

Solid lines = frail, dashed lines = not frail.

Figure 2. Time to death by Fried Frailty Phenotype within the first year after transplant (A) and over four years after transplant (B)

Solid lines = frail, dashed lines = not frail.

Figure 2. Time to death by Fried Frailty Phenotype within the first year after transplant (A) and over four years after transplant (B)

Solid lines = frail, dashed lines = not frail.

Figure 3. Standardized mortality risk by SPPB and FFP Frailty status

The risk reflects the post-estimation marginalized standardized risk derived from a logistic regression model controlling for age, gender, diagnosis, forced vital capacity, Lung Allocation Score, and transplant center. The dots represent the point estimates for the adjusted standardized risk and the bars represent the 95% confidence intervals.