300 Section - Challenging the Frailty Forecast: Prehabilitation Opportunities and 90-Day Outcomes in Lung Transplant Recipients

Frailty is a known risk factor for poor outcomes in lung transplantation. The short physical performance battery (SPPB) is a commonly used frailty measurement tool and low SPPB score correlates with poor outcomes (i.e., never receiving a transplant, increased morbidity and mortality after transplantation). It remains unclear whether individuals with low SPPB scores who improve their frailty status have outcomes comparable to those who were never scored as frail. This study investigates the feasibility of systematically assessing frailty and examines if frailty on initial assessment of transplant candidacy impacts post-transplant survival and readmission rates.

Design:

Retrospective analysis of electronic health records from lung transplant recipients in one US center from 2022-2025.  Readmission or death rates within 90 days post-transplantation were compared between two groups by frailty status change with survival analyses.

Results: Over three years, 128 of the 160 individuals who underwent lung transplantation had 1 SPPB score and 39 had scores at two timepoints (mean 249.5 days between scores (SD=186.0)). Physiatry coordinated pre-transplant frailty assessments and individualized multimodal prehabilitation plan. Individuals who changed frailty status (initially frail to not frail, n=10) and who were never frail (n=28) had similar 90-day readmission or death rates across unadjusted (χ²=0.06, p=0.8135) and adjusted analyses controlling for age and body mass index (HR=0.62, p =0.414). The initially frail patients improved a median of 4 points (IQR 4-5) on their SPPB prior to transplantation.

Conclusion:

Pre-transplant frailty assessments were performed for most patients prior to transplant. Frail patients at initial presentation improved their scores changing their frailty status and had similar 90-day post-discharge readmission or mortality rates compared to those who never presented as frail. These findings show that frailty measures can be systematically collected to identify transplant candidates who may benefit from interventions that improve frailty, ultimately increasing transplant eligibility and extending life.