*Purpose: Pre-transplant risk factors are strongly associated with worse post-transplant survival (e.g. frailty); however, effective pre-transplant strategies to improve outcomes are lacking. We hypothesize that interventions targeting candidates’ self-management skills may be an effective tool applied to risk factors such as frailty or obesity. Little is known about self-management in lung transplant candidates.

*Methods: This is an IRB-approved, multi-center survey of adult lung waitlisted patients. Patients were approached by mail and asked to complete self-administered surveys including the 30-item Self-Management Abilities Scale (SMAS-30). The Self-management of Well-being provides the theoretical basis for the SMAS-30, a well-validated self-management questionnaire (Cronbach’s alpha 0.9). The theory states that one must be able to manage internal and external resources in order to maintain physical and social well-being. Survey non-responders were approached three times before declaring non-participation.

*Results: One hundred and fifty-nine candidates completed surveys (48% participation rate). Respondents averaged 59 years old (standard deviation [SD]±9.5). Half were male. The majority of the patients had high school diploma or higher (92%), were married (74%), and were white (93.7%). Median wait time was 94 days with a mean lung allocation score (LAS) of 36.3. Overall median SMAS-30 score was 71.5 (interquartile range [IQR] 60,79.8). About 7.5% of lung transplant candidates had a total SMAS-30 score > 1 SD below expected values based on reported norms. Subdomains of Investment, Positive Frame of Mind, and Multi-Functionality were > 1 SD below expected for 8, 7, and 15% of lung candidates, respectively. Most concerning, the Variety subdomain score was > 1 SD lower than expected for 53% of lung candidates, median 45 (IQR 35, 60). The Variety subdomain represents the ability to maintain resources for the various dimensions of physical and social well-being.

*Conclusions: The Variety subdomain was lower than expected in lung transplant candidates on the waiting list. Such a deficit may reflect an opportunity for pre-transplant interventions targeting potentially modifiable risk factors. Deficiencies in overall score or other subdomains may prove important targets for select candidates.Self-management is a novel consideration for pre-transplant intervention. Future research targeting deficiencies in the Variety subdomain should be considered.

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