Abstract
BACKGROUND: As lung transplantation (LT) expands to older recipients, objective approaches to evaluate the aging are needed to optimize posttransplantation outcomes. Frailty assessment and sarcopenia have shown promise as tools for predicting clinical outcomes. METHODS: Patients older than 55 years undergoing evaluation for LT were enrolled in an institutional review board-approved study. Sarcopenia was measured on pretransplantation chest computed tomography images, measuring cross-sectional area and average attenuation of the pectoralis major muscle at 1 slice above the aortic arch. Frailty was measured using the Fried frailty phenotype (FFP) and Short Performance Physical Battery (SPPB). RESULTS: The study evaluated 84 patients with results of computed tomography of the chest available for review; 63% were classified as frail or prefrail by SPPB and 53% were frail by FFP. Sex-corrected sarcopenia was associated with frailty by FFP (P = .004) or SPPB (P = .044). Sarcopenia, measured by area or average attenuation, was significantly associated with length of stay after transplantation (P = .017 and P = .022, respectively), with a median 12 days for those with higher muscle mass compared with 21 days for those with lower muscle mass. Total time in the hospital in the first year after transplantation was also associated with sarcopenia by area (P = .090) or average attenuation (P = .046). CONCLUSIONS: A multifaceted approach to the evaluation of older patients can improve risk stratification, optimizing organ allocation to improve LT outcomes.