A Comparison of Frailty Measures at Listing to Predict Outcomes Following Lung Transplantation

Abstract Background Sarcopenia may be an important predictive factor on outcomes following lung transplantation (LTx). Serum albumin and six-minute walk distance (6MWD) have been shown to be a marker of outcomes in LTx. We sought to measure sarcopenia, albumin, and 6MWD in a cohort of LTx patients and analyze the utility of these as markers of outcomes for LTx patients. Methods We retrospectively identified LTx recipients from 2013-2018 at our institution who underwent computed tomography imaging during their listing evaluation. From that image, we measured skeletal muscle cross-sectional surface area at the 3rd lumbar vertebral level and sarcopenia was diagnosed by established cutoffs. Associations between sarcopenia, albumin, 6MWD and survival, hospital length of stay (LOS), complications, readmissions, and discharge destination were evaluated. Results 72%(95/132) of patients were sarcopenic, 18%(24/131) of patients were hypoalbuminemic, and 41% of patients had a low 6MWD. Survival was not associated with presence of sarcopenia (HR 1.06, 95% CI 0.46, 2.42)) or low 6MWD (HR 0.86, 95% CI 0.41, 1.83). Hospital LOS, complications, readmissions, and discharge destination were not influenced by sarcopenia or 6MWD. In contrast, hypoalbuminemia was independently associated with decreased survival (HR 2.25, 95% CI 1.04, 4.85) and a higher grade of postoperative complications (p=0.04). Conclusions Sarcopenia is prevalent in LTx patients. Neither sarcopenia or 6MWD predicted mortality or short-term outcomes following LTx. This is in contrast to albumin levels, which were inversely associated with survival and complications. Albumin shows promise as an important predictor of mortality and short-term outcomes following LTx .