Frailty predicts outcomes in cystic fibrosis patients listed for lung transplantation.

Details

Serval ID
serval:BIB_CE08DB438AE5
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Frailty predicts outcomes in cystic fibrosis patients listed for lung transplantation.
Journal
The Journal of heart and lung transplantation
Author(s)
Koutsokera A., Sykes J., Theou O., Rockwood K., Steinack C., Derkenne M.F., Benden C., Krueger T., Chaparro C., Aubert J.D., Soccal Gasche P., von Garnier C., Tullis E., Stephenson A.L., Singer L.G.
ISSN
1557-3117 (Electronic)
ISSN-L
1053-2498
Publication state
In Press
Peer-reviewed
Oui
Language
english
Notes
Publication types: Journal Article
Publication Status: aheadofprint
Abstract
Survival predictors are not established for cystic fibrosis (CF) patients listed for lung transplantation (LT). Using the deficit accumulation approach, we developed a CF-specific frailty index (FI) to allow risk stratification for adverse waitlist and post-LT outcomes.
We studied adult CF patients listed for LT in the Toronto LT Program (development cohort 2005-2015) and the Swiss LT centres (validation cohort 2008-2017). Comorbidities, treatment, laboratory results and social support at listing were utilized to develop a lung disease severity index (LI deficits, d = 18), a frailty index (FI, d = 66) and a lifestyle/social vulnerability index (LSVI, d = 10). We evaluated associations of the indices with worsening waitlist status, hospital and ICU length of stay, survival and graft failure.
We studied 188 (Toronto cohort, 176 [94%] transplanted) and 94 (Swiss cohort, 89 [95%] transplanted) patients. The median waitlist times were 69 and 284 days, respectively. The median follow-up post-transplant was 5.3 and 4.7 years. At listing, 44.7% of patients were frail (FI ≥ 0.25) in the Toronto and 21.3% in the Swiss cohort. The FI was significantly associated with all studied outcomes in the Toronto cohort (FI and post-LT mortality, multivariable HR 1.74 [95%CI:1.24-2.45] per 0.1 point of the FI). In the Swiss cohort, the FI was associated with worsening waitlist status, post-LT mortality and graft failure.
In CF patients listed for LT, FI risk stratification was significantly associated with waitlist and post-LT outcomes. Studying frailty in young populations with advanced disease can provide insights on how frailty and deficit accumulation impacts survival.
Keywords
Transplantation, Cardiology and Cardiovascular Medicine, Pulmonary and Respiratory Medicine, Surgery, cystic fibrosis, frailty, lung transplantation outcomes
Pubmed
Open Access
Yes
Create date
24/07/2022 19:37
Last modification date
23/08/2022 5:44
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