Effects of Comorbidity and Frailty on Hospitalization and Mortality in Lung Transplant Recipients
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Updated: Jun 9, 2025
Author Spotlight: Investigating the Key Factors of Obliterative Bronchiolitis After Lung Transplantation
Published on: November 10, 2023
René Hage1, Eirini Chatzidaki, Maurice Roeder
1>From the Division of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland; and the Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland.
Objectives:
Recent advancements in lung transplantation have expanded donor and candidate criteria, challenging multidisciplinary teams to navigate ethical and clinical complexities in patient selection and management. Comorbidities and frailty substantially influence outcomes posttransplant, yet optimal assessment tools for frailty remain undetermined. This study investigated whether preoperative comorbidity and frailty assessments predict postoperative outcomes in lung transplant recipients.
Materials And Methods:
In this retrospective cohort study, we analyzed 68 adult patients who underwent single or bilateral lung transplant at the University Hospital Zurich in Zurich, Switzerland, between January 2022 and December 2023. We assessed comorbidity and frailty data by using the Varughese 40-variable frailty index and categorized deficits in comorbidity, laboratory values, and functional status. We classified comorbidity on the basis of prevalent diseases.
Results:
Among the cohort, 62 patients underwent bilateral transplant, including 2 patients who required retransplant. Of total patients, 42 were male patients, and mean age at transplant was 58 years. Mortality rates were notably higher among patients with 6 or more comorbidities compared patients who had less comorbidities, although definitive conclusions were limited by the small sample size (n = 5). Frailty index scores ranged from 0.05 to ≥0.20, with no scores below 0.05 observed. Higher frailty index (≥0.20) correlated with prolonged intensive care unit,thoracic ward, and rehabilitation center stays, as well as increased total hospitalization days and mortality, albeit with a small sample size limitation.
Conclusions:
This study assessed the effects of preoperative comorbidity and frailty on postoperative outcomes in lung transplant recipients. Higher comorbidity counts were linked to increased mortality, with 38% of patients with 6 or more comorbidities dying within the first year. A higher frailty index (≥0.20) was associated with longerintensive care unit, normal ward, and rehabilitation stays, higher total hospitalization days, and increased mortality.
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