Montgomery Elyn, Macdonald Peter S, Newton Phillip J, Chang Sungwon, Wilhelm Kay, Jha Sunita R, Malouf Monique
Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
Heart & Lung Transplant Program, St Vincent's Hospital, Sydney, NSW, Australia.
J Transplant. 2020 Aug 7;2020:3239495. doi: 10.1155/2020/3239495. eCollection 2020.
Frailty contributes to increased morbidity and mortality in patients referred for and undergoing lung transplantation (LTX). The study aim was to determine if frailty is reversible after LTX in those classified as frail at LTX evaluation.
Consecutive LTX recipients were included. All patients underwent modified physical frailty assessment during LTX evaluation. For patients assessed as frail, frailty was reassessed on completion of the post-LTX rehabilitation program. Frailty was defined by the presence of ≥ 3 domains of the modified Fried Frailty Phenotype (mFFP).
We performed 166 lung transplants (frail patients, = 27, 16%). Eighteen of the 27 frail patients have undergone frailty reassessment. Eight frail patients died, and one interstate recipient did not return for reassessment. In the 18 (66%) patients reassessed, there was an overall reduction in their frailty score post-LTX ((3.4 ± 0.6 to 1.0 ± 0.7), < 0.001) with 17/18 (94%) no longer classified as frail. Improvements were seen in the following frailty domains: exhaustion, mobility, appetite, and activity. Handgrip strength did not improve posttransplant.
Physical frailty was largely reversible following LTX, underscoring the importance of considering frailty a dynamic, not a fixed, entity. Further work is needed to identify those patients whose frailty is modifiable and establish specific interventions to improve frailty.
虚弱会导致接受肺移植（LTX）评估及接受肺移植手术的患者发病率和死亡率增加。本研究的目的是确定在LTX评估时被归类为虚弱的患者在LTX后虚弱是否可逆。
纳入连续的LTX受者。所有患者在LTX评估期间接受改良的身体虚弱评估。对于被评估为虚弱的患者，在LTX后康复计划完成后重新评估虚弱情况。虚弱由改良的弗里德虚弱表型（mFFP）中存在≥3个领域来定义。
我们进行了166例肺移植手术（虚弱患者27例，占16%）。27例虚弱患者中有18例接受了虚弱情况重新评估。8例虚弱患者死亡，1例州外受者未返回进行重新评估。在重新评估的18例（66%）患者中，LTX后他们的虚弱评分总体降低（从3.4±0.6降至1.0±0.7，P<0.001），18例中有17例（94%）不再被归类为虚弱。在以下虚弱领域有改善：疲惫、活动能力、食欲和活动。移植后握力没有改善。
LTX后身体虚弱在很大程度上是可逆的，这突出了将虚弱视为一个动态而非固定实体的重要性。需要进一步开展工作以确定那些虚弱情况可改变的患者，并制定改善虚弱的具体干预措施。
