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Monteagudo LJ, Diaz-Guerra GM, Badillo AÁ, Álvarez Martínez CJ, Pablo Gafas AD, Gámez García AP, López López E, Arriscado CM, Hawkins Carranza F. Health-Related Quality of Life Long-Term Study in Lung Transplant Patients: A Single-Center Experience. J Surg Res 2024; 299:313-321. [PMID: 38788468 DOI: 10.1016/j.jss.2024.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 02/29/2024] [Accepted: 04/20/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Health-related quality of life (HRQL) assessment plays a crucial role in the follow-up care of lung transplanted (LTx) patients. Previous reports have indicated that the HRQL achieved by these patients is often poorer compared to that of healthy individuals. However, the factors contributing to this lower HRQL remain unclear. This prospective study aimed to assess the effectiveness of using both a generic and a disease-specific HRQL instrument in evaluating the outcomes of patients who have undergone LTx. METHODS A total of 111 LTx patients were enrolled in the study, with 88 survivors completing the 5-year follow-up and 23 nonsurvivors identified within the first 3 y. Among the participants, 84 underwent double LTx, while 27 received a single LTx. Patients were interviewed before LTx, at 6 mo post-transplantation, and annually thereafter. Two validated instruments were utilized: the Euro quality of life five dimensions, a generic measure, and the St. George's Respiratory Questionnaire (SGRQ), a disease-specific questionnaire. RESULTS The study showed significant improvements in Euro Quality of Life five Dimensions scores from 6 mo after LTx. Specifically, the percentage of patients without Mobility problems increased from 23% before LTx to 71% at 5 y (P = <0.001), while the ability to self-care improved from 48% to 100% (P = <0.001). The ability to carry out usual activities improved from 13% to 86% (P = <0.001), and the proportion of patients without anxiety and depression increased from 50% to 86% (P > 0.004). However, there was no significant improvement observed in Pain, with only a slight reduction from 57% to 42.8% (P = 0.22). The SGRQ also showed improvements in all dimensions (symptoms, impact, activities) (P < 0.001). However, by the fifth year, the HRQL scores remained below normal reference values. Chronic graft dysfunction was associated with a decline in SGRQ scores. Bilateral LTx patients exhibited better SGRQ scores compared to unilateral LTx patients from the first year post-transplantation. Notably, there were no differences in scores between nonsurvivors and survivors. CONCLUSIONS The study highlights the long-term improvement in HRQL among LTx patients, with greater improvements observed in physical dimensions compared to psychological dimensions. Bilateral LTx was associated with better SGRQ scores than unilateral LTx, and chronic graft dysfunction primarily affected SGRQ scores. These findings underscore the importance of utilizing both generic and specific HRQL instruments in assessing LTx outcomes.
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Affiliation(s)
| | | | | | | | - Alicia De Pablo Gafas
- Lung Transplant Unit, University Hospital 12 Octubre, Complutense University, Madrid, Spain
| | | | - Eloisa López López
- Department of Anesthesiology, University Hospital 12 Octubre, Madrid, Spain
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Wang R, Peng F, Guo S, Sun J, Zhang S, Li X, Wei C, Liu H. Elements of Post-Transplant Recovery in Lung Transplant Recipients: A Scoping Review. Clin Nurs Res 2024:10547738241253644. [PMID: 38770918 DOI: 10.1177/10547738241253644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
To clarify and refine the specific elements of post-transplant recovery in lung transplant recipients, we explored the four dimensions of recovery: physiological, psychological, social, and habitual. This study is a scoping review. Two authors conducted a comprehensive electronic literature search to identify studies published from the establishment of the database to August 2022. Deductive coding was utilized to identify and categorize elements using a predefined list of the four components (physiological, psychological, social, and habitual recovery) based on the framework of post-transplant recovery proposed by Lundmark et al. Inductive coding was applied for concepts requiring further classification. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guideline. Systematic searching identified 8,616 potential records, of which 51 studies met the inclusion criteria. Ten subdimensions and their corresponding elements were identified and categorized into four dimensions of recovery following lung transplantation. The subdimensions included physiological recovery (including symptom experience, complications, physical function, and energy reserve), psychological recovery (encompassing affective distress, psychological adaptation, and transition from illness to health), social recovery (involving family adaptation and social adaptation), and habit recovery (focusing on health behavior).
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Affiliation(s)
- Ruiting Wang
- Beijing University of Chinese Medicine, Beijing, China
| | - Fucong Peng
- Beijing University of Chinese Medicine, Beijing, China
| | - Shaobo Guo
- Beijing University of Chinese Medicine, Beijing, China
| | - Jing Sun
- China-Japan Friendship Hospital, Beijing, China
| | - Shuping Zhang
- Beijing University of Chinese Medicine, Beijing, China
| | - Xiangru Li
- Beijing University of Chinese Medicine, Beijing, China
| | - Changyun Wei
- Beijing University of Chinese Medicine, Beijing, China
| | - Hongxia Liu
- Beijing University of Chinese Medicine, Beijing, China
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Singer JP, Christie JD, Diamond JM, Anderson MA, Benvenuto LA, Gao Y, Arcasoy SM, Lederer DJ, Calabrese D, Wang P, Hays SR, Kukreja J, Venado A, Kolaitis NA, Leard LE, Shah RJ, Kleinhenz ME, Golden J, Betancourt L, Oyster M, Zaleski D, Adler J, Kalman L, Balar P, Patel S, Medikonda N, Koons B, Tevald M, Covinsky KE, Greenland JR, Katz PK. Development of the Lung Transplant Frailty Scale (LT-FS). J Heart Lung Transplant 2023; 42:892-904. [PMID: 36925382 PMCID: PMC11022684 DOI: 10.1016/j.healun.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/02/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Existing measures of frailty developed in community dwelling older adults may misclassify frailty in lung transplant candidates. We aimed to develop a novel frailty scale for lung transplantation with improved performance characteristics. METHODS We measured the short physical performance battery (SPPB), fried frailty phenotype (FFP), Body Composition, and serum Biomarkers representative of putative frailty mechanisms. We applied a 4-step established approach (identify frailty domain variable bivariate associations with the outcome of waitlist delisting or death; build models sequentially incorporating variables from each frailty domain cluster; retain variables that improved model performance ability by c-statistic or AIC) to develop 3 candidate "Lung Transplant Frailty Scale (LT-FS)" measures: 1 incorporating readily available clinical data; 1 adding muscle mass, and 1 adding muscle mass and research-grade Biomarkers. We compared construct and predictive validity of LT-FS models to the SPPB and FFP by ANOVA, ANCOVA, and Cox proportional-hazard modeling. RESULTS In 342 lung transplant candidates, LT-FS models exhibited superior construct and predictive validity compared to the SPPB and FFP. The addition of muscle mass and Biomarkers improved model performance. Frailty by all measures was associated with waitlist disability, poorer HRQL, and waitlist delisting/death. LT-FS models exhibited stronger associations with waitlist delisting/death than SPPB or FFP (C-statistic range: 0.73-0.78 vs. 0.57 and 0.55 for SPPB and FFP, respectively). Compared to SPPB and FFP, LT-FS models were generally more strongly associated with delisting/death and improved delisting/death net reclassification, with greater improvements with increasing LT-FS model complexity (range: 0.11-0.34). For example, LT-FS-Body Composition hazard ratio for delisting/death: 6.0 (95%CI: 2.5, 14.2), SPPB HR: 2.5 (95%CI: 1.1, 5.8), FFP HR: 4.3 (95%CI: 1.8, 10.1). Pre-transplant LT-FS frailty, but not SPPB or FFP, was associated with mortality after transplant. CONCLUSIONS The LT-FS is a disease-specific physical frailty measure with face and construct validity that has superior predictive validity over established measures.
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Affiliation(s)
- Jonathan P Singer
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA.
| | - Jason D Christie
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, PA, USA
| | - Joshua M Diamond
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, PA, USA
| | - Michaela A Anderson
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, PA, USA
| | - Luke A Benvenuto
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, Villanova, Pennsylvania
| | - Ying Gao
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA
| | - Selim M Arcasoy
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, Villanova, Pennsylvania
| | | | - Daniel Calabrese
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA; Medical Service, San Francisco VA Health Care System, San Francisco, California
| | - Ping Wang
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA
| | - Steven R Hays
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA
| | - Jasleen Kukreja
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA
| | - Aida Venado
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA
| | - Nicholas A Kolaitis
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA
| | - Lorriana E Leard
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA
| | - Rupal J Shah
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA
| | - Mary Ellen Kleinhenz
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA
| | - Jeffrey Golden
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA
| | - Legna Betancourt
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA
| | - Michelle Oyster
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, PA, USA
| | - Derek Zaleski
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, PA, USA
| | - Joe Adler
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, PA, USA
| | - Laurel Kalman
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, PA, USA
| | - Priya Balar
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, PA, USA
| | - Shreena Patel
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, Villanova, Pennsylvania
| | - Nikhila Medikonda
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA
| | - Brittany Koons
- College of Nursing, Villanova University, Villanova, PA, USA
| | | | - Kenneth E Covinsky
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California
| | - John R Greenland
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA; Medical Service, San Francisco VA Health Care System, San Francisco, California
| | - Patti K Katz
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, California
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Singer JP, Calfee CS, Delucchi K, Diamond JM, Anderson MA, Benvenuto LA, Gao Y, Wang P, Arcasoy SM, Lederer DJ, Hays SR, Kukreja J, Venado A, Kolaitis NA, Leard LE, Shah RJ, Kleinhenz ME, Golden J, Betancourt L, Oyster M, Brown M, Zaleski D, Medikonda N, Kalman L, Balar P, Patel S, Calabrese DR, Greenland JR, Christie JD. Subphenotypes of frailty in lung transplant candidates. Am J Transplant 2023; 23:531-539. [PMID: 36740192 PMCID: PMC11005295 DOI: 10.1016/j.ajt.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 12/16/2022] [Accepted: 12/30/2022] [Indexed: 02/05/2023]
Abstract
Heterogeneous frailty pathobiology might explain the inconsistent associations observed between frailty and lung transplant outcomes. A Subphenotype analysis could refine frailty measurement. In a 3-center pilot cohort study, we measured frailty by the Short Physical Performance Battery, body composition, and serum biomarkers reflecting causes of frailty. We applied latent class modeling for these baseline data. Next, we tested class construct validity with disability, waitlist delisting/death, and early postoperative complications. Among 422 lung transplant candidates, 2 class model fit the best (P = .01). Compared with Subphenotype 1 (n = 333), Subphenotype 2 (n = 89) was characterized by systemic and innate inflammation (higher IL-6, CRP, PTX3, TNF-R1, and IL-1RA); mitochondrial stress (higher GDF-15 and FGF-21); sarcopenia; malnutrition; and lower hemoglobin and walk distance. Subphenotype 2 had a worse disability and higher risk of waitlist delisting or death (hazards ratio: 4.0; 95% confidence interval: 1.8-9.1). Of the total cohort, 257 underwent transplant (Subphenotype 1: 196; Subphenotype 2: 61). Subphenotype 2 had a higher need for take back to the operating room (48% vs 28%; P = .005) and longer posttransplant hospital length of stay (21 days [interquartile range: 14-33] vs 18 days [14-28]; P = .04). Subphenotype 2 trended toward fewer ventilator-free days, needing more postoperative extracorporeal membrane oxygenation and dialysis, and higher need for discharge to rehabilitation facilities (P ≤ .20). In this early phase study, we identified biological frailty Subphenotypes in lung transplant candidates. A hyperinflammatory, sarcopenic Subphenotype seems to be associated with worse clinical outcomes.
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Affiliation(s)
- Jonathan P Singer
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA.
| | - Carolyn S Calfee
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA
| | - Kevin Delucchi
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Joshua M Diamond
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michaela A Anderson
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Luke A Benvenuto
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York City, New York, USA
| | - Ying Gao
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA
| | - Ping Wang
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA; San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Selim M Arcasoy
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York City, New York, USA
| | | | - Steven R Hays
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA
| | - Jasleen Kukreja
- Division of Cardiothoracic Surgery, University of California, San Francisco, California, USA
| | - Aida Venado
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA
| | - Nicholas A Kolaitis
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA
| | - Lorianna E Leard
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA
| | - Rupal J Shah
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA
| | - Mary Ellen Kleinhenz
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA
| | - Jeffrey Golden
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA
| | - Legna Betancourt
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA
| | - Michelle Oyster
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melanie Brown
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Derek Zaleski
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nikhila Medikonda
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA
| | - Laurel Kalman
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Priya Balar
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shreena Patel
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York City, New York, USA
| | - Daniel R Calabrese
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA; San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - John R Greenland
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA; San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Jason D Christie
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Rudym D, Natalini JG, Trindade AJ. Listing Dilemmas: Age, Frailty, Weight, Preexisting Cancers, and Systemic Diseases. Clin Chest Med 2023; 44:35-46. [PMID: 36774166 DOI: 10.1016/j.ccm.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Selection of lung transplant candidates is an evolving field that pushes the boundaries of what is considered the norm. Given the continually changing demographics of the typical lung transplant recipient as well as the growing list of risk factors that predispose patients to poor posttransplant outcomes, we explore the dilemmas in lung transplant candidate selections pertaining to older age, frailty, low and high body mass index, preexisting cancers, and systemic autoimmune rheumatic diseases.
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Affiliation(s)
- Darya Rudym
- Division of Pulmonary and Critical Care Medicine, New York University, Langone Health, 530 First Avenue, HCC-4A, New York, NY 10016, USA.
| | - Jake G Natalini
- Division of Pulmonary and Critical Care Medicine, New York University, Langone Health, 530 First Avenue, HCC-4A, New York, NY 10016, USA
| | - Anil J Trindade
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Oxford House, Room 539, 1313 21st Avenue South, Nashville, TN 37232, USA
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Lai JC, Shui AM, Duarte-Rojo A, Rahimi RS, Ganger DR, Verna EC, Volk ML, Kappus M, Ladner DP, Boyarsky B, Segev DL, Gao Y, Huang CY, Singer JP. Association of Frailty With Health-Related Quality of Life in Liver Transplant Recipients. JAMA Surg 2023; 158:130-138. [PMID: 36515937 PMCID: PMC9856900 DOI: 10.1001/jamasurg.2022.6387] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 08/23/2022] [Indexed: 12/15/2022]
Abstract
Importance Frailty has been recognized as a risk factor for mortality after liver transplant (LT) but little is known of its association with functional status and health-related quality of life (HRQL), termed global functional health, in LT recipients. Objective To evaluate the association between pre-LT and post-LT frailty with post-LT global functional health. Design, Setting, and Participants This prospective cohort study was conducted at 8 US LT centers and included adults who underwent LT from October 2016 to February 2020. Exposures Frail was defined by a pre-LT Liver Frailty Index (LFI) score of 4.5 or greater. Main Outcomes and Measures Global functional health at 1 year after LT, assessed using surveys (Short Form-36 [SF-36; summarized by physical component scores (PFC) and mental component summary scores (MCS)], Instrumental Activities of Daily Living scale) and performance-based tests (LFI, Fried Frailty Phenotype, and Short Physical Performance Battery). Results Of 358 LT recipients (median [IQR] age, 60 [53-65] years; 115 women [32%]; 25 [7%] Asian/Pacific Islander, 21 [6%] Black, 54 [15%] Hispanic White, and 243 [68%] non-Hispanic White individuals), 68 (19%) had frailty pre-LT. At 1 year post-LT, the median (IQR) PCS was lower in recipients who had frailty vs those without frailty pre-LT (42 [31-53] vs 50 [38-56]; P = .002), but the median MCS was similar. In multivariable regression, pre-LT frailty was associated with a -5.3-unit lower post-LT PCS (P < .001), but not MCS. The proportion who had difficulty with 1 or more Instrumental Activities of Daily Living (21% vs 10%) or who were unemployed/receiving disability (38% vs 29%) was higher in recipients with vs without frailty. In a subgroup of 210 recipients with LFI assessments 1 year post-LT, 13% had frailty at 1 year post-LT. Recipients who had frailty post-LT reported lower adjusted SF-36-PCS scores (coefficient, -11.4; P < .001) but not SF-36-MCS scores. Recipients of LT who had frailty vs those without frailty 1 year post-LT also had worse median (IQR) Fried Frailty Phenotype scores (1 [1-2] vs 1 [0-1]) and higher rates of functional impairment by a Short Physical Performance Battery of 9 or less (42% vs 20%; P = .01). Conclusions and Relevance In this cohort study, pre-LT frailty was associated with worse global functional health 1 year after LT. The presence of frailty after LT was also associated with worse HRQL in physical, but not mental, subdomains. These data suggest that interventions and therapeutics that target frailty that are administered before and/or early post-LT may help to improve the health and well-being of LT recipients.
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Affiliation(s)
- Jennifer C. Lai
- Department of Medicine, University of California, San Francisco
| | - Amy M. Shui
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Andres Duarte-Rojo
- Center for Liver Diseases, Thomas A. Starzl Transplantation Institute, Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert S. Rahimi
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas
| | - Daniel R. Ganger
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern Medicine, Chicago, Illinois
- Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Elizabeth C. Verna
- Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, New York
| | - Michael L. Volk
- Division of Gastroenterology & Hepatology, and Transplantation Institute, Loma Linda University Health, Loma Linda, California
| | - Matthew Kappus
- Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Daniela P. Ladner
- Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Division of Transplantation, Department of Surgery, Northwestern Medicine, Chicago, Illinois
| | - Brian Boyarsky
- New York University Grossman School of Medicine, New York
| | - Dorry L. Segev
- New York University Grossman School of Medicine, New York
| | - Ying Gao
- Department of Medicine, University of California, San Francisco
| | - Chiung-Yu Huang
- Department of Epidemiology and Biostatistics, University of California, San Francisco
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7
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Koons B, Anderson MR, Smith PJ, Greenland JR, Singer JP. The Intersection of Aging and Lung Transplantation: its Impact on Transplant Evaluation, Outcomes, and Clinical Care. CURRENT TRANSPLANTATION REPORTS 2022; 9:149-159. [PMID: 36341000 PMCID: PMC9632682 DOI: 10.1007/s40472-022-00365-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
Purpose Older adults (age ≥ 65 years) are the fastest growing age group undergoing lung transplantation. Further, international consensus document for the selection of lung transplant candidates no longer suggest a fixed upper age limit. Although carefully selected older adults can derive great benefit, understanding which older adults will do well after transplant with improved survival and health-related qualiy of life is key to informed decision-making. Herein, we review the epidemiology of aging in lung transplantation and its impact on outcomes, highlight selected physiological measures that may be informative when evaluating and managing older lung transplant patients, and identify directions for future research. Recent Findings In general, listing and transplanting older, sicker patients has contributed to worse clinical outcomes and greater healthcare use. Emerging evidence suggest that measures of physiological age, such as frailty, body composition, and neurocognitive and psychosocial function, may better identify risk for poor transplant outcomes than chronlogical age. Summary The evidence base to inform transplant decision-making and improvements in care for older adults is small but growing. Multipronged efforts at the intersection of aging and lung transplantation are needed to improve the clinical and patient centered outcomes for this large and growing cohort of patients. Future research should focus on identifying novel and ideally modifiable risk factors for poor outcomes specific to older adults, better approaches to measuring physiological aging (e.g., frailty, body composition, neurocognitive and psychosocial function), and the underlying mechanisms of physiological aging. Finally, interventions that can improve clinical and patient centered outcomes for older adults are needed.
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Affiliation(s)
- Brittany Koons
- M. Louise Fitzpatrick College of Nursing, Villanova University, 800 Lancaster Avenue, Driscoll Hall Room 350, Villanova, PA 19085, USA
| | - Michaela R. Anderson
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Patrick J. Smith
- Department of Psychiatry and Behavioral Sciences, Division of Behavioral Medicine and Neurosciences, Duke University Medical Center, Durham, NC, USA
| | - John R. Greenland
- Department of Medicine, University of California, San Francisco, CA, USA
- Medical Service, Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Jonathan P. Singer
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, UC San Francisco, San Francisco, CA, USA
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Tarrant BJ, Quinn E, Robinson R, Poulsen M, Fuller L, Snell G, Thompson BR, Button BM, Holland AE. Post-operative, inpatient rehabilitation after lung transplant evaluation (PIRATE): A feasibility randomized controlled trial. Physiother Theory Pract 2022:1-11. [PMID: 35193445 DOI: 10.1080/09593985.2022.2041779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Postoperative rehabilitation is crucial following lung transplantation (LTx); however, it is unclear whether intensive rehabilitation is feasible to deliver in the acute setting. We aimed to establish the feasibility and safety of intensive acute physiotherapy post-LTx. METHODS This feasibility trial randomized 40 adults following bilateral sequential LTx to either standard (once-daily) or intensive (twice-daily) physiotherapy. Primary outcomes were feasibility (recruitment and delivery of intensive intervention) and safety. Secondary outcomes included six-minute walk test; 60-second sit-to-stand; grip strength; physical activity; pain; EQ-5D-5L; length of stay; and readmissions. Data were collected at baseline, week 3, and week 10 post-LTx. ClinicalTrials.gov #NCT03095859. RESULTS Of 83 LTx completed during the trial, 49% were eligible and 48% provided consent. Median age was 61 years {range 18-70}; waitlist time 85 days [IQR 35-187]. Median time to first mobilization was 2 days [2-3]. Both groups received a median of 10 [7-14] standard interventions post-randomization. A median of 9 [6-18] individual intensive interventions were attempted (86% successful), the most common barrier being medical procedures/investigations (67%). No intervention-related adverse events or between-group differences in secondary outcomes were observed. CONCLUSIONS Acute, intensive physiotherapy was feasible and safe post-LTx. This trial provides data to underpin definitive trials to establish efficacy.
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Affiliation(s)
- Benjamin J Tarrant
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia.,Level 4, The Alfred Centre, La Trobe University, Melbourne, VIC, Australia
| | - Elizabeth Quinn
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia
| | - Rebecca Robinson
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia
| | - Megan Poulsen
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia
| | - Louise Fuller
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia.,John St, Swinburne University, Hawthorn, VIC, Australia
| | - Greg Snell
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia.,The Alfred, Monash University, Melbourne, VIC, Australia
| | - Bruce R Thompson
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia.,John St, Swinburne University, Hawthorn, VIC, Australia
| | - Brenda M Button
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia.,The Alfred, Monash University, Melbourne, VIC, Australia
| | - Anne E Holland
- Physiotherapy Department, 4th Floor Philip Block, the Alfred, Alfred Health, Melbourne, VIC, Australia.,Level 4, The Alfred Centre, La Trobe University, Melbourne, VIC, Australia.,The Alfred, Monash University, Melbourne, VIC, Australia
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9
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Abstract
Rationale: Sarcopenia is associated with disability and death. The optimal definition and clinical relevance of sarcopenia in lung transplantation remain unknown. Objectives: To assess the construct and predictive validity of sarcopenia definitions in lung transplant candidates. Methods: In a multicenter prospective cohort of 424 lung transplant candidates, we evaluated limited (muscle mass only) and expanded (muscle mass and quality) sarcopenia definitions from the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), the Foundation for the National Institutes of Health (FNIH), and a cohort-specific distribution-based lowest quartile definition. We assessed construct validity using associations with conceptually related factors. We evaluated the relationship between sarcopenia and frailty using generalized additive models. We also evaluated associations between sarcopenia definitions and key pretransplant outcomes, including disability (quantified by the Lung Transplant Valued Life Activities scale [range, 0-3; higher scores = worse disability; minimally important difference, 0.3]) and waitlist delisting/death, by multivariate linear and Cox regression, respectively. Results: Sarcopenia prevalence ranged from 6% to13% by definition used. The limited EWGSOP2 definition demonstrated the highest construct validity, followed by the expanded EWGSOP2 definition and both limited and expanded FNIH and lowest quartile definitions. Sarcopenia exhibited a linear association with the risk of frailty. The EWGSOP2 and expanded lowest quartile definitions were associated with disability, ranging from 0.20 to 0.25 higher Lung Transplant Valued Life Activities scores. Sarcopenia was associated with increased risk of waitlist delisting or death by the limited and expanded lowest quartile definitions (hazard ratio [HR], 3.8; 95% confidence interval [CI], 1.4-9.9 and HR, 3.5; 95% CI, 1.1-11.0, respectively) and the EWGSOP2 limited definition (HR, 2.8; 95% CI, 0.9-8.6) but not with the three other candidate definitions. Conclusions: The prevalence and validity of sarcopenia vary by definition; the EWGSOP2 limited definition exhibited the broadest validity in lung transplant candidates. The linear relationship between low muscle mass and frailty highlights sarcopenia's contribution to frailty and also questions the clinical utility of a sarcopenia cut-point in advanced lung disease. The associations between sarcopenia and important pretransplant outcomes support further investigation into using body composition for candidate risk stratification.
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10
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Diamond JM, Courtwright AM, Balar P, Oyster M, Zaleski D, Adler J, Brown M, Hays SR, Sutter N, Garvey C, Kukreja J, Gao Y, Bruun A, Smith PJ, Singer JP. Mobile health technology to improve emergent frailty after lung transplantation. Clin Transplant 2021; 35:e14236. [PMID: 33527520 DOI: 10.1111/ctr.14236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 12/18/2022]
Abstract
We evaluated the feasibility, safety, and efficacy of a mHealth-supported physical rehabilitation intervention to treat frailty in a pilot study of 18 lung transplant recipients. Frail recipients were defined by a short physical performance battery (SPPB score ≤7). The primary intervention modality was Aidcube, a customizable rehabilitation mHealth platform. Our primary aims included tolerability, feasibility, and acceptability of use of the platform, and secondary outcomes were changes in SPPB and in scores of physical activity, and disability measured using the Duke Activity Status Index (DASI) and Lung Transplant-Value Life Activities (LT-VLA). Notably, no adverse events were reported. Subjects reported the app was easy to use, usability improved over time, and the app enhanced motivation to engage in rehabilitation. Comments highlighted the complexities of immediate post-transplant rehabilitation, including functional decline, pain, tremor, and fatigue. At the end of the intervention, SPPB scores improved a median of 5 points from a baseline of 4. Physical activity and patient-reported disability also improved. The DASI improved from 4.5 to 19.8 and LT-VLA score improved from 2 to 0.59 at closeout. Overall, utilization of a mHealth rehabilitation platform was safe and well received. Remote rehabilitation was associated with improvements in frailty, physical activity and disability. Future studies should evaluate mHealth treatment modalities in larger-scale randomized trials of lung transplant recipients.
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Affiliation(s)
- Joshua M Diamond
- Pulmonary Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew M Courtwright
- Pulmonary Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Priya Balar
- Pulmonary Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Michelle Oyster
- Pulmonary Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Derek Zaleski
- Good Shepherd Penn Partners at the University of Pennsylvania, Philadelphia, USA
| | - Joe Adler
- Good Shepherd Penn Partners at the University of Pennsylvania, Philadelphia, USA
| | - Melanie Brown
- Pulmonary Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven R Hays
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nicole Sutter
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Chris Garvey
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jasleen Kukreja
- Division of Adult Cardiothoracic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ying Gao
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Patrick J Smith
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Jonathan P Singer
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, San Francisco, CA, USA
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11
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Kolaitis NA, Gao Y, Soong A, Greenland JR, Hays SR, Golden J, Leard LE, Shah RJ, Kleinhenz ME, Katz PP, Venado A, Kukreja J, Blanc PD, Singer JP. Primary graft dysfunction attenuates improvements in health-related quality of life after lung transplantation, but not disability or depression. Am J Transplant 2021; 21:815-824. [PMID: 32794295 DOI: 10.1111/ajt.16257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/17/2020] [Accepted: 07/31/2020] [Indexed: 01/25/2023]
Abstract
Disability, depressive symptoms, and impaired health-related quality of life (HRQL) are common among patients with life-threatening respiratory compromise. We sought to determine if primary graft dysfunction (PGD), a syndrome of acute lung injury, attenuates improvements in patient-reported outcomes after transplantation. In a single-center prospective cohort, we assessed disability, depressive symptoms, and HRQL before and at 3- to 6-month intervals after lung transplantation. We estimated the magnitude of change in disability, depressive symptoms, and HRQL with hierarchical segmented linear mixed-effects models. Among 251 lung transplant recipients, 50 developed PGD Grade 3. Regardless of PGD severity, participants had improvements in disability and depressive symptoms, as well as generic-physical, generic-mental, respiratory-specific, and health-utility HRQL, exceeding 1- to 4-fold the minimally clinically important difference across all instruments. Participants with PGD Grade 3 had a lower magnitude of improvement in generic-physical HRQL and health-utility than in all other participants. Among participants with PGD Grade 3, prolonged mechanical ventilation was associated with greater attenuation of improvements. PGD remains a threat to the 2 primary aims of lung transplantation, extending survival and improving HRQL. Attenuation of improvement persists long after hospital discharge. Future studies should assess if interventions can mitigate the impact of PGD on patient-reported outcomes.
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Affiliation(s)
- Nicholas A Kolaitis
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Ying Gao
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Allison Soong
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - John R Greenland
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Steven R Hays
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Jeffrey Golden
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Lorriana E Leard
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Rupal J Shah
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Mary Ellen Kleinhenz
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Patricia P Katz
- Division of Rheumatology, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Aida Venado
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Jasleen Kukreja
- Division of Thoracic Surgery, Department of Surgery, School of Medicine, University of California, San Francisco, California, USA
| | - Paul D Blanc
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Jonathan P Singer
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
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12
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Perez AA, Hays SR, Soong A, Gao Y, Greenland JR, Leard LE, Shah RJ, Golden J, Kukreja J, Venado A, Kleinhenz ME, Singer JP. Improvements in frailty contribute to substantial improvements in quality of life after lung transplantation in patients with cystic fibrosis. Pediatr Pulmonol 2020; 55:1406-1413. [PMID: 32237273 PMCID: PMC8048765 DOI: 10.1002/ppul.24747] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 03/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND While lung transplantation (LTx) improves health-related quality of life (HRQL) in cystic fibrosis (CF), the determinants of this improvement are unknown. In other populations, frailty-a syndrome of vulnerability to physiologic stressors-is associated with disability and poor HRQL. We hypothesized that improvements in frailty would be associated with improved disability and HRQL in adults with CF undergoing LTx. METHODS In a single-center prospective cohort study from 2010 to 2017, assessments of frailty, disability, and HRQL were performed before and at 3- and 6-months after LTx. We assessed frailty by the short physical performance battery (SPPB). We assessed disability with the Lung Transplant Valued Life Activities scale (LT-VLA) and HRQL by the Medical Outcomes Study Short Form Physical and Mental Component Summary scales (SF12-PCS, -MCS), the Airway Questionnaire 20-Revised (AQ20R), and the Euroqol 5D (EQ5D). We tested the association of concurrent changes in frailty and lung function on disability and HRQL by linear mixed-effects models adjusted for sex and body mass index. RESULTS Among 23 participants with CF, improvements in frailty and lung function were independently associated with improved disability and some HRQL measures. For example, each 1-point improvement in SPPB or 200 mL improvement in FEV1 was associated with improved LT-VLA disability by 0.14 (95%CI: 0.08-0.20) and 0.07 (95%CI: 0.05-0.09) points and improved EQ5D by 0.05 (95%CI: 0.03 to 0.07) and 0.02 (95%CI: 0.01-0.03) points, respectively. CONCLUSION Improvement in frailty is a novel determinant of improved disability and HRQL in adults with CF undergoing LTx.
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Affiliation(s)
- Alyssa A Perez
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Steven R Hays
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Allison Soong
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Ying Gao
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - John R Greenland
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Lorriana E Leard
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Rupal J Shah
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Jeffrey Golden
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Jasleen Kukreja
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Aida Venado
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Mary Ellen Kleinhenz
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Jonathan P Singer
- Department of Medicine, University of California San Francisco, San Francisco, California
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13
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Analysis of Optimal Health-Related Quality of Life Measures in Patients Waitlisted for Lung Transplantation. Can Respir J 2020; 2020:4912920. [PMID: 32211085 PMCID: PMC7077042 DOI: 10.1155/2020/4912920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 11/21/2019] [Indexed: 01/02/2023] Open
Abstract
Background Improving health-related quality of life (HRQL) is an important goal of lung transplantation, and St. George's Respiratory Questionnaire (SGRQ) is frequently used for assessing HRQL in patients waitlisted for lung transplantation. We hypothesized that chronic respiratory failure (CRF)-specific HRQL measures would be more suitable than the SGRQ, considering the underlying disease and its severity in these patients. Methods We prospectively collected physiological and patient-reported data (HRQL, dyspnea, and psychological status) of 199 patients newly registered in the waiting list of lung transplantation. CRF-specific HRQL measures of the Maugeri Respiratory Failure Questionnaire (MRF) and Severe Respiratory Insufficiency Questionnaire (SRI) were assessed in addition to the SGRQ. Results Compared to the MRF-26 and SRI, the score distribution of the SGRQ was skewed toward the worse ends of the scale. All domains of the MRF-26 and SRI were significantly correlated with the SGRQ. Multiple regression analyses to investigate factors predicting each HRQL score indicated that dyspnea and psychological status accounted for 12% to 28% of the variance more significantly than physiological measures did. The MRF-26 Total and SRI Summary significantly worsened from the baseline to 1 year (p < 0.001 and p < 0.001 and p < 0.001 and. Conclusions The MRF-26 and SRI are valid, discriminative, and responsive in patients waitlisted for lung transplantation. In terms of the score distribution and responsiveness, CRF-specific measures may function better in their HRQL assessment than the currently used measures do.
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14
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Singer JP, Soong A, Chen J, Shrestha P, Zhuo H, Gao Y, Greenland JR, Hays SR, Kukreja J, Golden J, Gregorich SE, Stewart AL. Development and Preliminary Validation of the Lung Transplant Quality of Life (LT-QOL) Survey. Am J Respir Crit Care Med 2020; 199:1008-1019. [PMID: 30303408 DOI: 10.1164/rccm.201806-1198oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RATIONALE Although lung transplantation aims to improve health-related quality of life (HRQL), existing instruments fail to include health domains considered important in this population. OBJECTIVES We aimed to develop a comprehensive lung transplant-specific instrument to address this shortcoming. METHODS We developed a pool of 126 candidate items addressing domains previously identified as important by lung transplant recipients. Through cognitive interviews conducted in 43 transplant recipients, items deemed irrelevant or redundant were dropped. The 84 remaining items were field tested in lung transplant recipients. Exploratory and confirmatory factor analyses were used to evaluate the factor structure, and scales were evaluated for internal consistency and construct validity. MEASUREMENTS AND MAIN RESULTS The 84-item preliminary survey was administered to 201 lung transplant recipients with a mean age of 57.9 (±12.7) years; 46% were female. After factor analyses and internal consistency evaluation, we retained 60 items comprising the Lung Transplant Quality of Life (LT-QOL) Survey. The LT-QOL contains 10 scales that measure symptoms, health perceptions, functioning, and well-being. The confirmatory factor analysis model had good approximate fit (comparative fit index = 0.990; standardized root-mean-square residual = 0.062). Cronbach αs for the 10 scales ranged from 0.75 to 0.95. Interscale correlations were consistent with hypothesized relationships. Subjects with severe chronic lung allograft dysfunction (n = 13) reported significantly worse HRQL than subjects without chronic lung allograft dysfunction (n = 168) on 6 of the 10 LT-QOL scales. CONCLUSIONS The LT-QOL is a new, multidimensional instrument that characterizes and quantifies HRQL in lung transplant recipients.
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Affiliation(s)
- Jonathan P Singer
- 1 Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine
| | - Allison Soong
- 1 Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine
| | - Joan Chen
- 1 Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine
| | - Pavan Shrestha
- 1 Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine
| | - Hanjing Zhuo
- 1 Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine
| | - Ying Gao
- 1 Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine
| | - John R Greenland
- 1 Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine
| | - Steven R Hays
- 1 Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine
| | | | - Jeffrey Golden
- 1 Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine
| | | | - Anita L Stewart
- 4 Institute for Health & Aging, University of California, San Francisco, San Francisco, California
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15
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Abstract
Existing methods of academic publication provide limited opportunity to obtain stakeholder input on issues of broad interest. This article reports the results of an experiment to produce a collaborative, crowdsourced article examining a current controversial issue in transplant medicine (hereby referred to as the "C4 Article"). The editorial team as a whole selected the topic of organ allocation, then divided into six sections, each supported by an individual editorial team. Widely promoted by the American Journal of Transplantation, the C4 Article was open for public comment for 1 month. The nonblinded editorial teams reviewed the contributions daily and interacted with contributors in near-real time to clarify and expand on the content received. Draft summaries of each section were posted and subsequently revised as new contributions were received. One hundred ninety-four individuals viewed the manuscript, and 107 individuals contributed to the manuscript during the submission period. The article engaged the international transplant community in producing a contemporary delineation of issues of agreement and controversy related to organ allocation and identified opportunities for new policy development. This initial experience successfully demonstrated the potential of a crowdsourced academic manuscript to advance a broad-based understanding of a complex issue.
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16
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Singer JP, Soong A, Bruun A, Bracha A, Chin G, Hays SR, Kukreja J, Rigler J, Golden JA, Greenland JR, Garvey C. A mobile health technology enabled home-based intervention to treat frailty in adult lung transplant candidates: A pilot study. Clin Transplant 2018; 32:e13274. [PMID: 29742287 DOI: 10.1111/ctr.13274] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Frailty is prevalent in lung transplant candidates (LTC) and is associated with waitlist delisting or death. We performed a pilot study to assess the safety and feasibility of a home-based, mobile health technology-facilitated intervention to treat frailty in LTC. METHODS We performed an 8-week, nonrandomized, home-based exercise and nutrition intervention in LTC with Short Physical Performance Battery (SPPB) frailty scores of ≤11. The intervention utilized a customized, mobile device application ("app") enabling monitoring and progression of the intervention in real time. We aimed to evaluate key process measures. Secondarily, we tested whether the intervention could improve frailty scores quantified by the SPPB and Fried Frailty Phenotype (FFP). RESULTS A total of 15 subjects enrolled were 63 ± 5.7 years old; oxygen requirements ranged from 3 to 15LPM. Thirteen subjects completed the intervention. Over 108 subject-weeks, there were no adverse events. Subjects found the app engaging and easy to work with. SPPB frailty improved in 7 (54%) and FFP improved in 8 (62%). There was a strong trend toward improved frailty scores (SPPB change 1.0 ± 1.9; P = .08; FFP change -0.6 ± 1.0; P = .07). CONCLUSION In this pilot study, we found that a home-based prehabilitation program that leverages mobile health technology to target frailty in LTC is well received, safe, and capable of improving physical frailty scores.
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Affiliation(s)
- Jonathan P Singer
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Allison Soong
- Department of Medicine, University of California, San Francisco, CA, USA
| | | | - Ayana Bracha
- Department of Nutrition and Food Services, University of California, San Francisco, CA, USA
| | - Greg Chin
- Department of Nutrition and Food Services, University of California, San Francisco, CA, USA
| | - Steven R Hays
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Jasleen Kukreja
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Julia Rigler
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Jeff A Golden
- Department of Medicine, University of California, San Francisco, CA, USA
| | - John R Greenland
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Chris Garvey
- Department of Medicine, University of California, San Francisco, CA, USA
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17
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Refining Low Physical Activity Measurement Improves Frailty Assessment in Advanced Lung Disease and Survivors of Critical Illness. Ann Am Thorac Soc 2018; 14:1270-1279. [PMID: 28398076 DOI: 10.1513/annalsats.201612-1008oc] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
RATIONALE The frail phenotype has gained popularity as a clinically relevant measure in adults with advanced lung disease and in critical illness survivors. Because respiratory disease and chronic illness can greatly limit physical activity, the measurement of participation in traditional leisure time activities as a frailty component may lead to substantial misclassification of frailty in pulmonary and critical care patients. OBJECTIVES To test and validate substituting the Duke Activity Status Index (DASI), a simple 12-item questionnaire, for the Minnesota Leisure Time Physical Activity (MLTA) questionnaire, a detailed questionnaire covering 18 leisure time activities, as the measure of low activity in the Fried frailty phenotype (FFP) instrument. METHODS In separate multicenter prospective cohort studies of adults with advanced lung disease who were candidates for lung transplant and older survivors of acute respiratory failure, we assessed the FFP using either the MLTA or the DASI. For both the DASI and MLTA, we evaluated content validity by testing floor effects and construct validity through comparisons with conceptually related factors. We tested the predictive validity of substituting the DASI for the MLTA in the FFP assessment using Cox models to estimate associations between the FFP and delisting/death before transplant in those with advanced lung disease and 6-month mortality in older intensive care unit (ICU) survivors. RESULTS Among 618 adults with advanced lung disease and 130 older ICU survivors, the MLTA had a substantially greater floor effect than the DASI (42% vs. 1%, and 49% vs. 12%, respectively). The DASI correlated more strongly with strength and function measures than did the MLTA in both cohorts. In models adjusting for age, sex, comorbidities, and illness severity, substitution of the DASI for the MLTA led to stronger associations of the FFP with delisting/death in lung transplant candidates (FFP-MLTA hazard ratio [HR], 1.42; 95% confidence interval [CI], 0.55-3.65; FFP-DASI HR, 2.99; 95% CI, 1.03-8.65) and with mortality in older ICU survivors (FFP-MLTA HR, 2.68; 95% CI, 0.62-11.6; FFP-DASI HR, 5.71; 95% CI, 1.34-24.3). CONCLUSIONS The DASI improves the construct and predictive validity of frailty assessment in adults with advanced lung disease or recent critical illness. This simple questionnaire should replace the more complex MLTA in assessing the frailty phenotype in these populations.
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18
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Singer JP, Katz PP, Soong A, Shrestha P, Huang D, Ho J, Mindo M, Greenland JR, Hays SR, Golden J, Kukreja J, Kleinhenz ME, Shah RJ, Blanc PD. Effect of Lung Transplantation on Health-Related Quality of Life in the Era of the Lung Allocation Score: A U.S. Prospective Cohort Study. Am J Transplant 2017; 17:1334-1345. [PMID: 27743488 PMCID: PMC6085872 DOI: 10.1111/ajt.14081] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/13/2016] [Accepted: 10/04/2016] [Indexed: 01/25/2023]
Abstract
Under the U.S. Lung Allocation Score (LAS) system, older and sicker patients are prioritized for lung transplantation (LT). The impact of these changes on health-related quality of life (HRQL) after transplant has not been determined. In a single-center prospective cohort study from 2010 to 2016, we assessed HRQL before and repeatedly after LT for up to 3 years using the SF12-Physical and Mental Health, the respiratory-specific Airway Questionnaire 20-Revised, and the Euroqol 5D/Visual Analog Scale utility measures by multivariate linear mixed models jointly modeled with death. We also tested changes in LT-Valued Life Activities disability, BMI, allograft function, and 6-min walk test exercise capacity as predictors of HRQL change. Among 211 initial participants (92% of those eligible), LT improved HRQL by all 5 measures (p < 0.05) and all but SF12-Mental Health improved by threefold or greater than the minimally clinically important difference. Compared to younger participants, those aged ≥65 improved less in SF12-Physical and Mental Health (p < 0.01). Improvements in disability accounted for much of the HRQL improvement. In the LAS era, LT affords meaningful and durable HRQL improvements, mediated by amelioration of disability. Identifying factors limiting HRQL improvement in selected subgroups, especially those aged ≥65, are needed to maximize the net benefits of LT.
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Affiliation(s)
- J P Singer
- Department of Medicine, University of California, San Francisco, CA
| | - P P Katz
- Department of Medicine, University of California, San Francisco, CA
| | - A Soong
- Department of Medicine, University of California, San Francisco, CA
| | - P Shrestha
- Department of Medicine, University of California, San Francisco, CA
| | - D Huang
- Department of Medicine, University of California, San Francisco, CA
| | - J Ho
- Department of Medicine, University of California, San Francisco, CA
| | - M Mindo
- Department of Medicine, University of California, San Francisco, CA
| | - J R Greenland
- Department of Medicine, University of California, San Francisco, CA
| | - S R Hays
- Department of Medicine, University of California, San Francisco, CA
| | - J Golden
- Department of Medicine, University of California, San Francisco, CA
| | - J Kukreja
- Department of Surgery, University of California, San Francisco, CA
| | - M E Kleinhenz
- Department of Medicine, University of California, San Francisco, CA
| | - R J Shah
- Department of Medicine, University of California, San Francisco, CA
| | - P D Blanc
- Department of Medicine, University of California, San Francisco, CA
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19
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Rohde KA, Schlei ZW, Katers KM, Weber AK, Brokhof MM, Hawes DS, Radford KL, Francois ML, Menninga NJ, Cornwell R, Benca R, Hayney MS, Dopp JM. Insomnia and Relationship With Immunosuppressant Therapy After Lung Transplantation. Prog Transplant 2017; 27:167-174. [PMID: 28617161 DOI: 10.1177/1526924817699960] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Lung transplant recipients are at high risk of developing sleep disorders such as insomnia, but the prevalence and features are currently poorly characterized within this population. Since these disorders are associated with increased morbidity and mortality, it is important to identify them to optimize the care of lung transplant recipients. We sought to evaluate the prevalence of insomnia within our university-based lung transplant clinic and determine whether a relationship exists between insomnia and exposure to immunosuppressant medications following transplantation. METHODS Participants were recruited through the University of Wisconsin Hospital and Clinics Lung Transplant Clinic (N = 125). Participants (n = 92) completed the adult sleep history questionnaire, which included the Insomnia Severity Index (ISI) to assess for insomnia (defined as ISI score >10). Cumulative tacrolimus exposure was determined in 73 patients by performing an area under the curve calculation to assess for a potential relationship between tacrolimus exposure and insomnia. RESULTS The prevalence of insomnia was 40% within this population. Although no difference in time since transplant was found, cumulative mean ± standard error of the mean tacrolimus exposure was significantly higher in patients with insomnia versus those without insomnia (17 190 ± 1673 ng·d/mL vs 12 130 ± 1630 ng·d/mL, respectively; P = .04). Estimated tacrolimus exposure was not greater with increasing frequency of insomnia complaints (analysis of variance P = .54). CONCLUSION In our population, insomnia is common after lung transplantation, with prevalence greater than the general population. Higher cumulative exposure to tacrolimus may contribute to insomnia in this group. Future research should investigate the relationship between immunosuppressant therapy and development of sleep disorders.
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Affiliation(s)
- Kalynn A Rohde
- 1 Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Zachary W Schlei
- 1 Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Krista M Katers
- 1 Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Ashley K Weber
- 1 Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Marissa M Brokhof
- 2 University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, Madison, WI, USA
| | - Donald S Hawes
- 2 University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, Madison, WI, USA
| | - Kelly L Radford
- 2 University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, Madison, WI, USA
| | - Mary L Francois
- 2 University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, Madison, WI, USA
| | - Nathan J Menninga
- 1 Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Richard Cornwell
- 3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Ruth Benca
- 4 Wisconsin Sleep Center and Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Mary S Hayney
- 1 Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - John M Dopp
- 1 Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
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Jones CA, Chapman DG, Weimersheimer P, Fernandez L, Mesa OA, Peters C, Vanaudenaerde BM, Norotsky MC, Vos R. The Burden of Cost in Bronchiolitis Obliterans Syndrome: Predictions for the Next Decade. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2016; 4:119-126. [PMID: 37661950 PMCID: PMC10471368 DOI: 10.36469/9815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
In health economics, costs can be divided into both direct and indirect categories. Direct costs tend to consist of medical costs, which are those directly attributed to health care interventions (e.g., hospitalizations, pharmaceuticals, devices), and non-medical direct costs such as monitoring and professional caregiving. Indirect costs tend to comprise those related to lost productivity due to illness (or treatment), burden on systems outside of the healthcare domain, and other costs that can sometimes outweigh the entire sum of direct healthcare costs. The most common life-threatening complication of lung and hematopoietic stem-cell transplantation (HSCT) is bronchiolitis obliterans syndrome (BOS). BOS is currently diagnosed as a 20% decline in the forced expiratory volume in one second (FEV1) from the best (baseline) post-transplantation value, and is a major cause of morbidity and mortality amongst lung and stem cell transplant patients. BOS affects half of all lung transplant patients within the first 5 years post-transplant, rising to the majority of patients (~80%) within the first decade following transplant. We estimated both direct and indirect costs for the first 10 years following BOS diagnosis, a viewpoint that highlights a tremendous imbalance between healthcare and non-healthcare costs. The lost workforce resulting from BOS-related infirmity will cost society more than $3.7 Billion over the next decade, a figure that is more than double the estimated 10-year cost of treating BOS ($1.4B), including diagnostics, immunosuppressives, and additional complications. As such, BOS is estimated to present a burden of cost that must be evaluated in a new light to include the wider societal perspective.
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Affiliation(s)
- Christopher A Jones
- Department of Surgery Vermont Cancer Center; Global Health Economics Unit of the Vermont Center for Clinical and Translational Science; University of Vermont College of Medicine, Burlington, Vermont, USA
| | - David G Chapman
- Woolcock Institute of Medical Research, Sydney Medical School Vermont Lung Center; University of Sydney, New South Wales, Australia
| | - Peter Weimersheimer
- Department of Surgery University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Luca Fernandez
- Global Health Economics Unit of the Vermont Center for Clinical and Translational Science
| | | | | | - Bart M Vanaudenaerde
- KU Leuven - University of Leuven, Department of Clinical and Experimental Medicine, Laboratory for Respiratory Diseases, Lung Transplant Unit; University Hospitals Leuven, Department of Respiratory Diseases, Lung Transplant and Respiratory Intermediate Care Unit, Leuven, Belgium
| | - Mitchell C Norotsky
- Department of Surgery University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Robin Vos
- KU Leuven - University of Leuven, Department of Clinical and Experimental Medicine, Laboratory for Respiratory Diseases, Lung Transplant Unit; University Hospitals Leuven, Department of Respiratory Diseases, Lung Transplant and Respiratory Intermediate Care Unit, Leuven, Belgium
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21
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Menninga NJ, Rohde KA, Schlei ZW, Katers KM, Weber AK, Brokhof MM, Hawes DS, Radford KL, Francois ML, Cornwell RD, Benca R, Hayney MS, Dopp JM. Restless Legs Syndrome Following Lung Transplantation: Prevalence and Relationship With Tacrolimus Exposure. Prog Transplant 2016; 26:149-56. [PMID: 27207403 DOI: 10.1177/1526924816640980] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CONTEXT Complications following lung transplantation are common and significantly reduce quality of life, and increase morbidity and mortality. Increasing evidence suggests sleep disorders are prevalent following lung transplantation, but factors associated with their development are not known. OBJECTIVES We sought to evaluate the prevalence of restless legs syndrome (RLS) in a lung transplant population and determine if a relationship exists between RLS and exposure to immunosuppressant medications. DESIGN, SETTING, AND PARTICIPANTS Subjects were recruited through the University of Wisconsin Hospital and Clinics Lung Transplant Clinic (N = 125). Participants (N = 81) completed sleep questionnaires, including the four RLS diagnostic criteria, insomnia severity index, and Sheehan disability scale. Cumulative tacrolimus exposure was determined in 62 subjects by calculating an area under the curve (AUC) to assess for a relationship with restless legs syndrome. RESULTS Prevalence of RLS was 35 percent. Cumulative mean ± SEM tacrolimus exposure was similar in patients with RLS versus those without RLS (17446 ± 1855 ng days/mL vs. 15303 ± 1643 ng days/mL, respectively; p = 0.42). Insomnia severity index scores (12.5 ± 1.0 vs 6.8 ± 0.7, p < 0.0001) and Sheehan disability scores (7.8 ± 1.3 vs 3.6 ± 0.6, p = 0.003) were significantly higher in those with vs those without RLS symptoms, respectively. CONCLUSIONS Our data confirms increased prevalence of RLS following lung transplantation reported by previous studies. RLS symptoms were not related to estimated tacrolimus exposure. Predictors of RLS following lung transplantation need to be further investigated to better identify and control RLS symptoms and reduce associated insomnia and disability.
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Affiliation(s)
- Nathan J Menninga
- Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Kalynn A Rohde
- Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Zachary W Schlei
- Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Krista M Katers
- Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Ashley K Weber
- Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Marissa M Brokhof
- University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, Madison, WI, USA
| | - Donald S Hawes
- University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, Madison, WI, USA
| | - Kelly L Radford
- University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, Madison, WI, USA
| | - Mary L Francois
- University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, Madison, WI, USA
| | - Richard D Cornwell
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Ruth Benca
- Wisconsin Sleep Center and Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Mary S Hayney
- Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - John M Dopp
- Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
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Singer JP, Diamond JM, Gries CJ, McDonnough J, Blanc PD, Shah R, Dean MY, Hersh B, Wolters PJ, Tokman S, Arcasoy SM, Ramphal K, Greenland JR, Smith N, Heffernan P, Shah L, Shrestha P, Golden JA, Blumenthal NP, Huang D, Sonett J, Hays S, Oyster M, Katz PP, Robbins H, Brown M, Leard LE, Kukreja J, Bacchetta M, Bush E, D'Ovidio F, Rushefski M, Raza K, Christie JD, Lederer DJ. Frailty Phenotypes, Disability, and Outcomes in Adult Candidates for Lung Transplantation. Am J Respir Crit Care Med 2016; 192:1325-34. [PMID: 26258797 DOI: 10.1164/rccm.201506-1150oc] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
RATIONALE Frailty is associated with morbidity and mortality in abdominal organ transplantation but has not been examined in lung transplantation. OBJECTIVES To examine the construct and predictive validity of frailty phenotypes in lung transplant candidates. METHODS In a multicenter prospective cohort, we measured frailty with the Fried Frailty Phenotype (FFP) and Short Physical Performance Battery (SPPB). We evaluated construct validity through comparisons with conceptually related factors. In a nested case-control study of frail and nonfrail subjects, we measured serum IL-6, tumor necrosis factor receptor 1, insulin-like growth factor I, and leptin. We estimated the association between frailty and disability using the Lung Transplant Valued Life Activities disability scale. We estimated the association between frailty and risk of delisting or death before transplant using multivariate logistic and Cox models, respectively. MEASUREMENTS AND MAIN RESULTS Of 395 subjects, 354 completed FFP assessments and 262 completed SPPB assessments; 28% were frail by FFP (95% confidence interval [CI], 24-33%) and 10% based on the SPPB (95% CI, 7-14%). By either measure, frailty correlated more strongly with exercise capacity and grip strength than with lung function. Frail subjects tended to have higher plasma IL-6 and tumor necrosis factor receptor 1 and lower insulin-like growth factor I and leptin. Frailty by either measure was associated with greater disability. After adjusting for age, sex, diagnosis, and transplant center, both FFP and SPPB were associated with increased risk of delisting or death before lung transplant. For every 1-point worsening in score, hazard ratios were 1.30 (95% CI, 1.01-1.67) for FFP and 1.53 (95% CI, 1.19-1.59) for SPPB. CONCLUSIONS Frailty is prevalent among lung transplant candidates and is independently associated with greater disability and an increased risk of delisting or death.
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Affiliation(s)
| | | | - Cynthia J Gries
- 3 Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | - Beverly Hersh
- 3 Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | | | - Nancy Smith
- 5 Department of Surgery, College of Physicians and Surgeons, and
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jasleen Kukreja
- 6 Department of Surgery, University of California, San Francisco, San Francisco, California
| | | | - Errol Bush
- 6 Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Frank D'Ovidio
- 5 Department of Surgery, College of Physicians and Surgeons, and
| | | | | | - Jason D Christie
- 2 Department of Medicine and.,7 Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - David J Lederer
- 4 Department of Medicine.,8 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Abstract
PURPOSE OF REVIEW This review summarizes recent advances concerning respiratory impairment and disability. RECENT FINDINGS The traditional impairment assessment approach, depending heavily on clinical pulmonary function testing to estimate the match between the patient's sustainable oxygen consumption and the workplace requirements, continues to be widely used. Recent work indicates the need to reassess underlying concepts for several reasons: The relationship between basic pulmonary function tests and sustainable oxygen consumption varies among patients and conditions. Studies of the respiratory demands of modern workplaces need to be updated. The concepts are less easily applied to asthma than other disorders. Research studies present differing definitions of 'disability', and therefore the methods of relating impairment (function loss) and disability require reassessment. Recent advances provide improved understanding of the large societal and personal impacts of respiratory impairment and disability. SUMMARY Clinicians, policymakers, and researchers should carefully consider how well the current highly specified impairment rating systems can be improved for accuracy and relevance to current home and work activities. In addition to measuring 'impairment', clinicians should consider factors affecting how impairments lead to disability.
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The Mini-OAKHQOL for knee and hip osteoarthritis quality of life was obtained following recent shortening guidelines. J Clin Epidemiol 2015; 69:70-8. [PMID: 26111768 DOI: 10.1016/j.jclinepi.2015.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 05/22/2015] [Accepted: 06/16/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To develop a short form of the knee and hip osteoarthritis quality of life questionnaire, the Mini-OAKHQOL, preserving the conceptual model and, as far as possible, the content and the psychometric properties of the original instrument. STUDY DESIGN AND SETTING A two-step shortening procedure was used: (1) a consensus Delphi method, with a panel of patients and another of professionals independently asked to select items and (2) a nominal group, where patients, professionals, and methodologists reached consensus on the final selection of items, using information from the panels and from modern measurement and classical test theory analyses. The psychometric properties of the Mini-OAKHQOL were assessed in an independent population-based sample of 581 subjects with knee or hip osteoarthritis. RESULTS The two-step shortening procedure resulted in a 20-item questionnaire. Confirmatory factor analysis showed preservation of the original five-dimensional structure. Rasch analyses showed the unidimensionality and invariance by sex, age, and joint of the main dimensions. Convergent validity, reproducibility, and internal consistency were similar to or better than those of the original OAKHQOL. CONCLUSIONS The 20-item Mini-OAKHQOL has good psychometric properties and can be used for the measurement of quality of life in subjects with osteoarthritis of the lower limbs.
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Singer JP, Chen J, Katz PP, Blanc PD, Kagawa-Singer M, Stewart AL. Defining novel health-related quality of life domains in lung transplantation: a qualitative analysis. Qual Life Res 2015; 24:1521-33. [PMID: 25471287 PMCID: PMC4456337 DOI: 10.1007/s11136-014-0875-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Health-related quality of life (HRQL) domains vary across disease conditions and are determined by standards, values, and priorities internal to patients. Although the clinical goals of lung transplantation are to improve patient survival and HRQL, what defines HRQL in lung transplantation is unknown. Employing a qualitative approach, we aimed to identify HRQL domains important in lung transplantation. METHODS We conducted semi-structured interviews in purposefully sampled lung transplant recipients (n = 8) representing a spectrum of ages, gender, indications for transplantation, and time since transplantation as well as healthcare practitioners representing a spectrum of practitioner types (n = 9). Grounded theory was used to identify HRQL domains important in lung transplantation, building on but going beyond domains already defined in the SF-36, the most commonly used instrument in this population. RESULTS In addition to confirming the relevance of the eight SF-36 domains, we identified 11 novel HRQL domains. Palliation of respiratory symptoms was identified as important. After transplant surgery, new HRQL domains emerged including: distressing symptoms spanning multiple organ systems, worry about infection and acute rejection, treatment burden, and depression. Further, patients identified challenges to intimacy, changes in social relationships, and problems with cognitive functioning. Saliently, worry about limited life expectancy was pervasive and impaired life planning. CONCLUSIONS We found that HRQL in lung transplantation is defined by both generic and transplant-specific domains. Delineating and refining these domains can inform efforts to improve clinical outcomes and HRQL measurement in lung transplantation.
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Affiliation(s)
- Jonathan Paul Singer
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California, San Francisco, 350 Parnassus Avenue, Suite 609, San Francisco, CA, 94117, USA,
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Maxwell BG, Mooney JJ, Lee PHU, Levitt JE, Chhatwani L, Nicolls MR, Zamora MR, Valentine V, Weill D, Dhillon GS. Increased resource use in lung transplant admissions in the lung allocation score era. Am J Respir Crit Care Med 2015; 191:302-8. [PMID: 25517213 DOI: 10.1164/rccm.201408-1562oc] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
RATIONALE In 2005, the lung allocation score (LAS) was implemented to prioritize organ allocation to minimize waiting-list mortality and maximize 1-year survival. It resulted in transplantation of older and sicker patients without changing 1-year survival. Its effect on resource use is unknown. OBJECTIVES To determine changes in resource use over time in lung transplant admissions. METHODS Solid organ transplant recipients were identified within the Nationwide Inpatient Sample (NIS) data from 2000 to 2011. Joinpoint regression methodology was performed to identify a time point of change in mean total hospital charges among lung transplant and other solid-organ transplant recipients. Two temporal lung transplant recipient cohorts identified by joinpoint regression were compared for baseline characteristics and resource use, including total charges for index hospitalization, charges per day, length of stay, discharge disposition, tracheostomy, and need for extracorporeal membrane oxygenation. MEASUREMENTS AND MAIN RESULTS A significant point of increased total hospital charges occurred for lung transplant recipients in 2005, corresponding to LAS implementation, which was not seen in other solid-organ transplant recipients. Total transplant hospital charges increased by 40% in the post-LAS cohort ($569,942 [$53,229] vs. $407,489 [$28,360]) along with an increased median length of stay, daily charges, and discharge disposition other than to home. Post-LAS recipients also had higher post-transplant use of extracorporeal membrane oxygenation (odds ratio, 2.35; 95% confidence interval, 1.56-3.55) and higher incidence of tracheostomy (odds ratio, 1.52; 95% confidence interval, 1.22-1.89). CONCLUSIONS LAS implementation is associated with a significant increase in resource use during index hospitalization for lung transplant.
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Affiliation(s)
- Bryan G Maxwell
- 1 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Chen F, Oga T, Yamada T, Sato M, Aoyama A, Chin K, Date H. Lung allocation score and health-related quality of life in Japanese candidates for lung transplantation. Interact Cardiovasc Thorac Surg 2015; 21:28-33. [DOI: 10.1093/icvts/ivv101] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/26/2015] [Indexed: 12/30/2022] Open
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28
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Bush A, Pavord I. Year in review 2014. Paediatric and adult clinical studies. Thorax 2015; 70:368-72. [DOI: 10.1136/thoraxjnl-2015-206880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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29
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Leon-Sarmiento FE, Rizzo-Sierra CV, Leon-Ariza JS, Leon-Ariza DS, Sobota R, Prada DG. A new neurometric dissection of the area-under-curve-associated jiggle of the motor evoked potential induced by transcranial magnetic stimulation. Physiol Behav 2015; 141:111-9. [DOI: 10.1016/j.physbeh.2015.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 01/09/2015] [Accepted: 01/13/2015] [Indexed: 10/24/2022]
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Abstract
Research in pulmonary transplantation is actively evolving in quality and scope to meet the challenges of a growing population of lung allograft recipients. In 2013, research groups leveraged large publicly available datasets in addition to multicenter research networks and single-center studies to make significant contributions to our knowledge and clinical care in the areas of donor use, clinical transplant outcomes, mechanisms of rejection, infectious complications, and chronic allograft dysfunction.
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Affiliation(s)
- Jamie L Todd
- 1 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
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