Development and Validation of a Lung Transplant-Specific Disability Questionnaire

187

216

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.Keywords: biomarker; body composition; disability; frailty; lung transplantation Author Contributions: J.P.S., J.M.D., C.J.G., P.D.B., P.P.K., J.D.C., and D.J.L. made substantial contributions to the conception and design of the work; J.P.S. wrote the first draft of the manuscript; and J.P.S., J

Section: Outcome Measures For Tests Of Associationmentioning

confidence: 99%

Frailty Phenotypes, Disability, and Outcomes in Adult Candidates for Lung Transplantation

Singer¹,

Diamond²,

Gries

et al. 2015

187

216

“…Further exploration of the effect of LAS implementation on both long-term resource use and health-related quality of life is integral to informing decisions on how to measure transplant benefit and design organ allocation policy. Historically, these efforts have been limited by absence of validated patientcentered outcome assessment tools in lung transplantation patients; however, a validated questionnaire has recently been developed (26). Transplant registries should begin capturing pertinent nonmortality outcomes in both waiting list and recipient patients.…”

Section: Discussionmentioning

confidence: 99%

Increased Resource Use in Lung Transplant Admissions in the Lung Allocation Score Era

Maxwell

Mooney

Lee

et al. 2015

Rationale: In 2005, the lung allocation score (LAS) was implemented to prioritize organ allocation to minimize waiting-list mortality and maximize 1-year survival. It resulted in transplantation of older and sicker patients without changing 1-year survival. Its effect on resource use is unknown.Objectives: To determine changes in resource use over time in lung transplant admissions.Methods: Solid organ transplant recipients were identified within the Nationwide Inpatient Sample (NIS) data from 2000 to 2011. Joinpoint regression methodology was performed to identify a time point of change in mean total hospital charges among lung transplant and other solid-organ transplant recipients. Two temporal lung transplant recipient cohorts identified by joinpoint regression were compared for baseline characteristics and resource use, including total charges for index hospitalization, charges per day, length of stay, discharge disposition, tracheostomy, and need for extracorporeal membrane oxygenation.Measurements and Main Results: A significant point of increased total hospital charges occurred for lung transplant recipients in 2005, corresponding to LAS implementation, which was not seen in other solid-organ transplant recipients. Total transplant hospital charges increased by 40% in the post-LAS cohort ($569,942 [$53,229] vs. $407,489 [$28,360]) along with an increased median length of stay, daily charges, and discharge disposition other than to home. Post-LAS recipients also had higher post-transplant use of extracorporeal membrane oxygenation (odds ratio, 2.35; 95% confidence interval, 1.56-3.55) and higher incidence of tracheostomy (odds ratio, 1.52; 95% confidence interval, 1.22-1.89).Conclusions: LAS implementation is associated with a significant increase in resource use during index hospitalization for lung transplant.

“…Thus, increased attention to support mood and psychological health is needed to maximize the potential QOL benefits of lung transplantation (23). Additionally, the development of novel patient-reported outcome tools in lung transplant recipients, as described by Singer and colleagues (25), may enhance our understanding of disability within this patient subset, enable assimilation of patient-centered metrics into transplant decision making, and help PULMONARY, SLEEP, AND CRITICAL CARE UPDATE address these unmet psychological needs in the future (26).…”

Section: Survival and Quality Of Lifementioning

confidence: 99%

Update in Lung Transplantation 2013

Todd

Christie

Palmer

2014

Research in pulmonary transplantation is actively evolving in quality and scope to meet the challenges of a growing population of lung allograft recipients. In 2013, research groups leveraged large publicly available datasets in addition to multicenter research networks and single-center studies to make significant contributions to our knowledge and clinical care in the areas of donor use, clinical transplant outcomes, mechanisms of rejection, infectious complications, and chronic allograft dysfunction.