Cumulative Deficits Frailty Index Predicts Outcomes for Solid Organ Transplant Candidates

Background. Despite comprehensive multidisciplinary candidacy assessments to determine appropriateness for solid organ transplantation, limitations persist in identifying candidates at risk of adverse outcomes. Frailty measures may help inform candidacy evaluation. Our main objective was to create a...

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Main Authors: Rhea A. Varughese, MD, Olga Theou, PhD, Yanhong Li, MSc, Xiaojin Huang, RN-MN, Noori Chowdhury, MPH, Olusegun Famure, MPH, MEd, Nazia Selzner, MD, PhD, Jane MacIver, RN-NP, PhD, Sunita Mathur, PhD, S. Joseph Kim, MD, PhD, Kenneth Rockwood, MD, Lianne G. Singer, MD
Format: Article
Language:English
Published: Wolters Kluwer 2021-03-01
Series:Transplantation Direct
Online Access:http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001094
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spelling doaj-c6b4ae1b905840ebb5dc0127ee0b34412021-06-28T03:16:04ZengWolters KluwerTransplantation Direct2373-87312021-03-0173e67710.1097/TXD.0000000000001094202103000-00014Cumulative Deficits Frailty Index Predicts Outcomes for Solid Organ Transplant CandidatesRhea A. Varughese, MD0Olga Theou, PhD1Yanhong Li, MSc2Xiaojin Huang, RN-MN3Noori Chowdhury, MPH4Olusegun Famure, MPH, MEd,5Nazia Selzner, MD, PhD6Jane MacIver, RN-NP, PhD7Sunita Mathur, PhD8S. Joseph Kim, MD, PhD9Kenneth Rockwood, MD10Lianne G. Singer, MD111 Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.4 Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.1 Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.1 Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.1 Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.1 Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.1 Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.1 Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.8 Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.1 Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.4 Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.1 Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.Background. Despite comprehensive multidisciplinary candidacy assessments to determine appropriateness for solid organ transplantation, limitations persist in identifying candidates at risk of adverse outcomes. Frailty measures may help inform candidacy evaluation. Our main objective was to create a solid organ transplant frailty index (FI), using the cumulative deficits model, from data routinely collected during candidacy assessments. Secondary objectives included creating a social vulnerability index (SVI) from assessment data and evaluating associations between the FI and assessment, waitlist, and posttransplant outcomes. Methods. In this retrospective cohort study of solid organ transplant candidates from Toronto General Hospital, cumulative deficits FI and SVI were created from data collected during candidacy evaluations for consecutive kidney, heart, liver, and lung transplant candidates. Regression modeling measured associations between the FI and transplant listing, death or removal from the transplant waitlist, and survival after waitlist placement. Results. For 794 patients, 40 variable FI and 10 variable SVI were created (258 lung, 222 kidney, 201 liver, and 113 heart transplant candidates). The FI correlated with assessment outcomes; patients with medical contraindications (mean FI 0.35 ± 0.10) had higher FI scores than those listed (0.29 ± 0.09), P < 0.001. For listed patients, adjusted for age, sex, transplant type, and SVI, higher FI was associated with an increased risk of death (pretransplant or posttransplant) or delisting (hazard ratio 1.03 per 0.01 FI score, 95% confidence interval, 1.01-1.05, P = 0.01). Conclusions. A cumulative deficits FI can be derived from routine organ transplant candidacy evaluations and may identify candidates at higher risk of adverse outcomes.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001094
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language English
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author Rhea A. Varughese, MD
Olga Theou, PhD
Yanhong Li, MSc
Xiaojin Huang, RN-MN
Noori Chowdhury, MPH
Olusegun Famure, MPH, MEd,
Nazia Selzner, MD, PhD
Jane MacIver, RN-NP, PhD
Sunita Mathur, PhD
S. Joseph Kim, MD, PhD
Kenneth Rockwood, MD
Lianne G. Singer, MD
spellingShingle Rhea A. Varughese, MD
Olga Theou, PhD
Yanhong Li, MSc
Xiaojin Huang, RN-MN
Noori Chowdhury, MPH
Olusegun Famure, MPH, MEd,
Nazia Selzner, MD, PhD
Jane MacIver, RN-NP, PhD
Sunita Mathur, PhD
S. Joseph Kim, MD, PhD
Kenneth Rockwood, MD
Lianne G. Singer, MD
Cumulative Deficits Frailty Index Predicts Outcomes for Solid Organ Transplant Candidates
Transplantation Direct
author_facet Rhea A. Varughese, MD
Olga Theou, PhD
Yanhong Li, MSc
Xiaojin Huang, RN-MN
Noori Chowdhury, MPH
Olusegun Famure, MPH, MEd,
Nazia Selzner, MD, PhD
Jane MacIver, RN-NP, PhD
Sunita Mathur, PhD
S. Joseph Kim, MD, PhD
Kenneth Rockwood, MD
Lianne G. Singer, MD
author_sort Rhea A. Varughese, MD
title Cumulative Deficits Frailty Index Predicts Outcomes for Solid Organ Transplant Candidates
title_short Cumulative Deficits Frailty Index Predicts Outcomes for Solid Organ Transplant Candidates
title_full Cumulative Deficits Frailty Index Predicts Outcomes for Solid Organ Transplant Candidates
title_fullStr Cumulative Deficits Frailty Index Predicts Outcomes for Solid Organ Transplant Candidates
title_full_unstemmed Cumulative Deficits Frailty Index Predicts Outcomes for Solid Organ Transplant Candidates
title_sort cumulative deficits frailty index predicts outcomes for solid organ transplant candidates
publisher Wolters Kluwer
series Transplantation Direct
issn 2373-8731
publishDate 2021-03-01
description Background. Despite comprehensive multidisciplinary candidacy assessments to determine appropriateness for solid organ transplantation, limitations persist in identifying candidates at risk of adverse outcomes. Frailty measures may help inform candidacy evaluation. Our main objective was to create a solid organ transplant frailty index (FI), using the cumulative deficits model, from data routinely collected during candidacy assessments. Secondary objectives included creating a social vulnerability index (SVI) from assessment data and evaluating associations between the FI and assessment, waitlist, and posttransplant outcomes. Methods. In this retrospective cohort study of solid organ transplant candidates from Toronto General Hospital, cumulative deficits FI and SVI were created from data collected during candidacy evaluations for consecutive kidney, heart, liver, and lung transplant candidates. Regression modeling measured associations between the FI and transplant listing, death or removal from the transplant waitlist, and survival after waitlist placement. Results. For 794 patients, 40 variable FI and 10 variable SVI were created (258 lung, 222 kidney, 201 liver, and 113 heart transplant candidates). The FI correlated with assessment outcomes; patients with medical contraindications (mean FI 0.35 ± 0.10) had higher FI scores than those listed (0.29 ± 0.09), P < 0.001. For listed patients, adjusted for age, sex, transplant type, and SVI, higher FI was associated with an increased risk of death (pretransplant or posttransplant) or delisting (hazard ratio 1.03 per 0.01 FI score, 95% confidence interval, 1.01-1.05, P = 0.01). Conclusions. A cumulative deficits FI can be derived from routine organ transplant candidacy evaluations and may identify candidates at higher risk of adverse outcomes.
url http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001094
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