The importance of frailty in lung transplantation and chronic lung disease

Frailty is a state of functional decline and increased vulnerability to adverse health outcomes, associated with increased inflammation and dysregulated immune and physiological systems. Frailty plays an important role in morbidity and mortality in elderly patients and is emerging as an important risk factor in chronic diseases and solid organ transplant patients. There is no consensus as to the best frailty measure, and a multitude of options are available to researchers and clinicians. The prevalence in chronic lung disease and solid organ transplant varies by organ and frailty measurement type but appears higher than in elderly community populations. Frailty has been linked to removal from the transplant waiting list, mortality, delayed graft function, and length of stay in transplant populations. Much work remains to discover methods to prevent or reverse frailty. Encouragingly, studies suggest that frailty is not a permanent state and may be responsive to exercise training.