*Purpose: Lung transplantation is a lifesaving therapy in patients with advanced lung disease. However, frail lung transplant candidates are more likely to be delisted or die on the waitlist. There is a need to objectively identify frailty and assess potential reversible risk factors in potential lung transplant candidates.

*Methods: We prospectively assessed frailty in 25 consecutive lung transplant candidates using the Fried Frailty Phenotype (FFP), Short physical performance battery (SPPB) tools and the Montreal Cognitive Assessment (MoCA). We determined prevalence and risk factors associated with frailty utilizing multivariable logistic regression analysis after adjusting for covariates.

*Results: We evaluated 25 lung transplant candidates. The mean age was 60 ± 8 years, 9 of whom were female. Their primary diagnoses included COPD (24%), IPF (12%), ILD (28%) and Other (24%). Of the 25 lung transplant candidates, 12/25 (48%) were frail (7) or pre- frail (5) by the SPPB and 23/25 (92%) were frail (8) or pre-frail (15) by the FFP (p < 0.05). We found similar prevalence of frailty among the different underlying diagnoses (COPD, IPF, ILD, Other). After adjusting for several covariates, there was an association between decreased diffusing capacity (DLCO) and increased frailty by SPPB.

*Conclusions: Frailty is highly prevalent in lung transplant candidates but varies by the frailty tool. Frailty is associated with decreased DLCO. Further evaluation of risk factors for frailty and mitigation of these risk factors may enhance patient outcomes post lung transplantation. Further evaluation of frailty in larger populations are needed to validate these findings.

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