Date: Monday, May 1, 2017
Session Name: Concurrent Session: Disparities in Organ Transplantation
Session Time: 4:30pm-6:00pm
Presentation Time: 5:18pm-5:30pm
Introduction: Frailty is a clinical state associated with decreased function and increased vulnerability to physiologic stressors, leading to adverse medical outcomes. The cumulative deficits model conceptualizes frailty according to the number of deficits (symptoms, signs, abnormal laboratory values, disease states, and disabilities) present in an individual. This model has characterized frailty across the age spectrum and in many chronic health conditions. Our objectives were to create a frailty index (FI), using the cumulative deficits approach, to measure frailty in solid organ transplant candidates and to predict candidacy outcomes.
Methods: We performed a retrospective cohort analysis, collecting seventy-four clinical variables from transplant candidacy assessment data for 764 patients referred for organ transplantation (111 heart, 214 kidney, 195 liver, and 244 lung; 36.3% female; age range 18-74) at a single centre. We constructed a cumulative deficits FI using a standardized procedure. One-way ANOVA was used to compare frailty levels by transplant type and referral and listing outcomes.
Results: The FI consisted of 41 clinical variables. Liver transplant candidates were more frail than other organ groups (liver – mean FI 0.33 +/- 0.08, lung – 0.28 +/- 0.09, heart – 0.29 +/- 0.11, kidney – 0.27 +/- 0.09). As frailty increases, fewer subjects were listed for transplant or received transplant. Subjects declined for listing (n=140, mean FI 0.33 +/- 0.10) or who died (n=48, mean FI 0.34 +/- 0.09) during assessment were more frail than subjects who were listed (n=482, mean FI 0.28 +/- 0.09), p<0.0001. Those who were transplanted (n=350, mean FI 0.28 +/- 0.09) were less frail than those removed from the transplant waitlist for contraindications (n=30, mean FI 0.33 +/- 0.09) or death (n=51, mean FI 0.32 +/- 0.09), p<0.0001.
Conclusions: An FI can be developed from transplant candidacy assessment data and is associated with acceptance for transplant listing and receiving a transplant across multiple organ groups.
CITATION INFORMATION: Varughese R, Theou O, Huang X, Famure O, Li Y, Chowdhury N, Renner E, Kim J, MacIver J, Mathur S, Rockwood K, Singer L. Cumulative Deficits Frailty Index for Transplant Candidates Predicts Candidacy for Solid Organ Transplantation. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Varughese R, Theou O, Huang X, Famure O, Li Y, Chowdhury N, Renner E, Kim J, MacIver J, Mathur S, Rockwood K, Singer L. Cumulative Deficits Frailty Index for Transplant Candidates Predicts Candidacy for Solid Organ Transplantation. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/cumulative-deficits-frailty-index-for-transplant-candidates-predicts-candidacy-for-solid-organ-transplantation/. Accessed October 31, 2020.
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