Frailty Linked To Lower Survival in Lung Transplant Patients

Cassie Kennedy, M.D. Pulmonology and Critical Care Medicine Mayo Clinic

Dr. Cassie Kennedy Interview with:
Cassie Kennedy, M.D.
Pulmonology and Critical Care Medicine
Mayo Clinic 

Medical Research: What is the background for this study?

Dr. Kennedy: Lung transplant is a surgical procedure that can offer extended life expectancy and improved quality of life to selected patients with end-stage lung disease. However there are about 1700 patients awaiting lung transplant at any given time in the United States because transplant recipients far exceed potential donors.  In addition, even with carefully chosen candidates, lung transplant recipients live on average about 5.5 years.  It is therefore very important for transplant physicians to choose patients who will receive the most benefit from their lung transplant.

Frailty (defined as an increased vulnerability to adverse health outcomes) has typically been a subjective consideration by transplant physicians when choosing lung transplant candidates.  The emergence of more objective and reproducible frailty measures from the geriatric literature present an opportunity to study the prevalence of frailty in lung transplant (despite that subjective screening) and to determine whether the presence of frailty has any impact on patient outcomes.

Medical Research: What are the main findings?

Dr. Kennedy: Frailty is quite common –46 percent of our patient cohort was frail by the Frailty Deficit Index. We also saw a significant association between frailty and worsened survival following lung transplantation: one-year survival rate for frail patients was 71.7 percent, compared to 92.9 percent for patients who were not frail. At three years this difference in survival persisted–the survival rate for frail patients was 41.3 percent, compared to 66.1 percent for patients who were not frail.

Medical Research: What should clinicians and patients take away from your report?

Dr. Kennedy: First, that frailty appears to be very common in lung transplant candidates and, second, that frail patients have a higher associated mortality following lung transplantation.  For a clinician this may mean that frailty measures beyond a clinician’s subjective judgement (such as the Frailty Deficit Index) may be useful adjunctive screening tools in assessing lung transplant candidacy. For patients without frailty it may mean better expected survival.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Kennedy: Both lung transplant patients and clinicians will want to know:

1) can frailty can be reversed? and

2) if frailty is reversed do lung transplant outcomes improve?  These are the questions my clinical research laboratory is focused on now.


Michael E. Wilson, Abhay P. Vakil, Pujan Kandel, Chaitanya Undavalli, Shannon M. Dunlay, Cassie C. Kennedy. Pretransplant frailty is associated with decreased survival after lung transplantation. The Journal of Heart and Lung Transplantation, 2015; DOI:10.1016/j.healun.2015.10.014


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Last Updated on December 23, 2015 by Marie Benz MD FAAD