Courtwright Andrew M, Zaleski Derek, Tevald Michael, Adler Joe, Singer Jonathan P, Cantu Edward E, A Bermudez Christian, Diamond Joshua M
Pulmonary and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Good Shepard Penn Partners, Philadelphia, Pennsylvania.
Clin Transplant. 2019 Oct;33(10):e13694. doi: 10.1111/ctr.13694. Epub 2019 Sep 8.
Frailty at listing for lung transplant has been associated with waitlist and post-transplant mortality. Frailty trajectories following transplant, however, have been less well characterized, including whether recipient frailty improves. The objective of this study was to identify prevalence and risk factors for frailty at discharge and to evaluate changes in frail recipients enrolled in an outpatient physical therapy program.
This was a single-center prospective cohort study of lung transplant recipients. Enrollees completed a short physical performance battery (SPPB) to assess frailty at listing and at initial hospital discharge.
Of the 111 enrolled recipients, none were frail at listing and 18 (16.2%) were prefrail. At discharge, however, 60 (54.1%) patients were frail. Discharge frailty was associated with prefrailty at listing, acute kidney injury post-transplant, and longer intensive care unit stay. Among the 35 patients who were frail at discharge and who were enrolled in an outpatient PT program, the median improvement in SPPB was 6 points (IQR = 5-7 points), and 85.7% became not frail over a median of 6 weeks.
Discharge frailty is common following lung transplantation. In most frail patients, an intensive outpatient physical therapy program is associated with improvement in frailty, as assessed by the SPPB.
肺移植登记时的虚弱状态与等待名单上的死亡率及移植后死亡率相关。然而，移植后的虚弱轨迹特征尚不明确，包括受者的虚弱状态是否改善。本研究的目的是确定出院时虚弱的患病率和危险因素，并评估参加门诊物理治疗项目的虚弱受者的变化情况。
这是一项针对肺移植受者的单中心前瞻性队列研究。参与者完成了简短体能测试（SPPB），以评估登记时和首次出院时的虚弱状态。
在111名登记的受者中，登记时无虚弱者，18名（16.2%）为虚弱前期。然而，出院时，60名（54.1%）患者虚弱。出院时的虚弱与登记时的虚弱前期、移植后急性肾损伤以及较长的重症监护病房住院时间有关。在35名出院时虚弱且参加门诊物理治疗项目的患者中，SPPB的中位改善值为6分（四分位间距=5-7分），85.7%的患者在中位6周时间内不再虚弱。
肺移植后出院时虚弱很常见。在大多数虚弱患者中，一项强化门诊物理治疗项目与通过SPPB评估的虚弱状态改善相关。
