Frailty assessment and candidate optimization before cardiothoracic transplantation

Frailty is an important syndrome in an aging thoracic transplant population, particularly in the context of end-stage cardiopulmonary disease. In this review, we discuss the core problem of lack of physiologic reserve in these patients and its relationship to perioperative outcomes, how to define and measure frailty in the context of heart and lung transplant and identify interventions to treat contributors to this clinical syndrome. We highlight the critical need in the transplant community to identify and treat these conditions prior to their transplantation and to prevent comorbidity and mortality.