Institute of Nursing Science, Faculty of Medicine, University of Basel, Switzerland.
Institute of Nursing Science, Faculty of Medicine, University of Basel, Switzerland; Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium.
Transplant Rev (Orlando). 2017 Jul;31(3):218-224. doi: 10.1016/j.trre.2017.03.003. Epub 2017 Mar 30.
There is growing consensus that frailty, a state of vulnerability and a decline in functioning across multiple physiological body systems, is a valuable criterion to guide clinicians' risk prediction for poor outcomes in adult transplant candidates. In its 2016 listing criteria for heart transplantation the International Society for Heart Lung Transplantation recommends frailty assessment. We aimed to summarize the usefulness of frailty assessment in heart transplant candidates or recipients reported throughout the literature.
We performed a systematic literature search in PubMed to identify papers reporting on frailty in transplantation, chronic heart failure, and ventricualr assist device implantation published over the last 10 years in English. Additionally, a hand search was conducted, including manually searching the reference lists and a citation search of relevant papers.
Eleven primary research articles were included in this systematic review. Frailty is a risk factor for morbidity, hospitalization, and mortality in patients with advanced heart failure and individuals being considered for ventricualr assist device implantation. Of the patients being considered for transplantation, 33% are frail. The Frailty Phenotype by Fried is a particularly useful tool to quickly identify higher risk patients for adverse outcomes.
A lack of standardization and limited evidence on frailty in transplantation limit its use as a definitive listing criterion. Future research efforts should focus on systematic integration of frailty measures in transplant practice.
越来越多的人认为，衰弱是一种易受伤害的状态，是多个生理身体系统功能下降的表现，这是指导临床医生预测成人移植候选者不良结局风险的一个有价值的标准。国际心肺移植学会在其 2016 年心脏移植入选标准中建议进行衰弱评估。我们旨在总结文献中报告的衰弱评估在心脏移植候选者或受者中的有用性。
我们在 PubMed 中进行了系统的文献检索，以确定在过去 10 年中用英文发表的关于移植、慢性心力衰竭和心室辅助装置植入中衰弱的报告。此外，还进行了手工搜索，包括手动搜索参考文献列表和相关论文的引文搜索。
本系统评价共纳入 11 篇原始研究文章。衰弱是晚期心力衰竭患者和考虑植入心室辅助装置患者发病率、住院率和死亡率的一个危险因素。在考虑移植的患者中，有 33%是衰弱的。弗里德的衰弱表型是一种快速识别高风险不良结局患者的特别有用的工具。
移植中衰弱的缺乏标准化和有限的证据限制了其作为明确列入标准的使用。未来的研究工作应侧重于系统地将衰弱措施纳入移植实践中。
