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Kahn J, Wagner D, Homfeld N, Müller H, Kniepeiss D, Schemmer P. Both sarcopenia and frailty determine suitability of patients for liver transplantation-A systematic review and meta-analysis of the literature. Clin Transplant 2018; 32:e13226. [DOI: 10.1111/ctr.13226] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Judith Kahn
- Division of Transplant Surgery; Medical University of Graz; Graz Austria
- Transplant Center Graz (TCG); Medical University of Graz; Graz Austria
| | - Doris Wagner
- Division of General Surgery; Medical University of Graz; Graz Austria
| | - Nicole Homfeld
- Division of Transplant Surgery; Medical University of Graz; Graz Austria
- Transplant Center Graz (TCG); Medical University of Graz; Graz Austria
| | - Helmut Müller
- Division of Transplant Surgery; Medical University of Graz; Graz Austria
- Transplant Center Graz (TCG); Medical University of Graz; Graz Austria
| | - Daniela Kniepeiss
- Division of Transplant Surgery; Medical University of Graz; Graz Austria
- Transplant Center Graz (TCG); Medical University of Graz; Graz Austria
| | - Peter Schemmer
- Division of Transplant Surgery; Medical University of Graz; Graz Austria
- Transplant Center Graz (TCG); Medical University of Graz; Graz Austria
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Singer JP, Diamond JM, Gries CJ, McDonnough J, Blanc PD, Shah R, Dean MY, Hersh B, Wolters PJ, Tokman S, Arcasoy SM, Ramphal K, Greenland JR, Smith N, Heffernan P, Shah L, Shrestha P, Golden JA, Blumenthal NP, Huang D, Sonett J, Hays S, Oyster M, Katz PP, Robbins H, Brown M, Leard LE, Kukreja J, Bacchetta M, Bush E, D'Ovidio F, Rushefski M, Raza K, Christie JD, Lederer DJ. Frailty Phenotypes, Disability, and Outcomes in Adult Candidates for Lung Transplantation. Am J Respir Crit Care Med 2016; 192:1325-34. [PMID: 26258797 DOI: 10.1164/rccm.201506-1150oc] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
RATIONALE Frailty is associated with morbidity and mortality in abdominal organ transplantation but has not been examined in lung transplantation. OBJECTIVES To examine the construct and predictive validity of frailty phenotypes in lung transplant candidates. METHODS In a multicenter prospective cohort, we measured frailty with the Fried Frailty Phenotype (FFP) and Short Physical Performance Battery (SPPB). We evaluated construct validity through comparisons with conceptually related factors. In a nested case-control study of frail and nonfrail subjects, we measured serum IL-6, tumor necrosis factor receptor 1, insulin-like growth factor I, and leptin. We estimated the association between frailty and disability using the Lung Transplant Valued Life Activities disability scale. We estimated the association between frailty and risk of delisting or death before transplant using multivariate logistic and Cox models, respectively. MEASUREMENTS AND MAIN RESULTS Of 395 subjects, 354 completed FFP assessments and 262 completed SPPB assessments; 28% were frail by FFP (95% confidence interval [CI], 24-33%) and 10% based on the SPPB (95% CI, 7-14%). By either measure, frailty correlated more strongly with exercise capacity and grip strength than with lung function. Frail subjects tended to have higher plasma IL-6 and tumor necrosis factor receptor 1 and lower insulin-like growth factor I and leptin. Frailty by either measure was associated with greater disability. After adjusting for age, sex, diagnosis, and transplant center, both FFP and SPPB were associated with increased risk of delisting or death before lung transplant. For every 1-point worsening in score, hazard ratios were 1.30 (95% CI, 1.01-1.67) for FFP and 1.53 (95% CI, 1.19-1.59) for SPPB. CONCLUSIONS Frailty is prevalent among lung transplant candidates and is independently associated with greater disability and an increased risk of delisting or death.
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Affiliation(s)
| | | | - Cynthia J Gries
- 3 Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | - Beverly Hersh
- 3 Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | | | - Nancy Smith
- 5 Department of Surgery, College of Physicians and Surgeons, and
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jasleen Kukreja
- 6 Department of Surgery, University of California, San Francisco, San Francisco, California
| | | | - Errol Bush
- 6 Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Frank D'Ovidio
- 5 Department of Surgery, College of Physicians and Surgeons, and
| | | | | | - Jason D Christie
- 2 Department of Medicine and.,7 Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - David J Lederer
- 4 Department of Medicine.,8 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Pretransplant frailty is associated with decreased survival after lung transplantation. J Heart Lung Transplant 2015; 35:173-8. [PMID: 26679297 DOI: 10.1016/j.healun.2015.10.014] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 09/03/2015] [Accepted: 10/14/2015] [Indexed: 02/07/2023] Open
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.
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Lai JC, Feng S, Terrault NA, Lizaola B, Hayssen H, Covinsky K. Frailty predicts waitlist mortality in liver transplant candidates. Am J Transplant 2014; 14:1870-9. [PMID: 24935609 PMCID: PMC4107151 DOI: 10.1111/ajt.12762] [Citation(s) in RCA: 343] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 02/28/2014] [Accepted: 03/15/2014] [Indexed: 01/25/2023]
Abstract
We aimed to determine whether frailty, a validated geriatric construct of increased vulnerability to physiologic stressors, predicts mortality in liver transplant candidates. Consecutive adult outpatients listed for liver transplant with laboratory Model for End-Stage Liver Disease (MELD) ≥ 12 at a single center (97% recruitment rate) underwent four frailty assessments: Fried Frailty, Short Physical Performance Battery (SPPB), Activities of Daily Living (ADL) and Instrumental ADL (IADL) scales. Competing risks models associated frailty with waitlist mortality (death/delisting for being too sick for liver transplant). Two hundred ninety-four listed liver transplant patients with MELD ≥ 12, median age 60 years and MELD 15 were followed for 12 months. By Fried Frailty score ≥3, 17% were frail; 11/51 (22%) of the frail versus 25/243 (10%) of the not frail died/were delisted (p = 0.03). Each 1-unit increase in the Fried Frailty score was associated with a 45% (95% confidence interval, 4-202) increased risk of waitlist mortality adjusted for MELD. Similarly, the adjusted risk of waitlist mortality associated with each 1-unit decrease (i.e. increasing frailty) in the Short Physical Performance Battery (hazard ratio 1.19, 95% confidence interval 1.07-1.32). Frailty is prevalent in liver transplant candidates. It strongly predicts waitlist mortality, even after adjustment for liver disease severity demonstrating the applicability and importance of the frailty construct in this population.
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Affiliation(s)
- Jennifer C. Lai
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California-San Francisco, San Francisco, CA
| | - Sandy Feng
- Department of Surgery, Division of Transplant Surgery, University of California-San Francisco, San Francisco, CA
| | - Norah A. Terrault
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California-San Francisco, San Francisco, CA
| | - Blanca Lizaola
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California-San Francisco, San Francisco, CA
| | - Hilary Hayssen
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California-San Francisco, San Francisco, CA
| | - Kenneth Covinsky
- Department of Medicine, Division of Geriatrics, University of California-San Francisco, San Francisco, CA
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