Cumulative Deficit Frailty Index in Cystic Fibrosis Lung Transplantation Candidates
Description: Cystic Fibrosis (CF) is the most common fatal genetic disease affecting children and young adults. It is estimated that approximately 1 in every 3.600 children born has CF. It is associated with a defective protein which disrupts the balance of salt and water needed to maintain normal mucus. Repeated lung infections leading to a reduction in lung function are the clinical hallmark of CF. Despite aggressive medical therapy, lung disease is a common cause of disability and shortened life span. For patients with advanced lung disease, lung transplantation (LT) may be life-saving but the procedure itself may be associated with high risks. Frailty is defined as a loss in one or more domains of human functioning (physical, psychological and social) and it may be the result of increasing age but may be observed in young subjects as a result of a disease. It is associated with a risk of death, worse quality of life and higher needs of medical care. Very limited information is available in the literature regarding frailty in lung transplantation and cystic fibrosis. The hypothesis of the study is that a cumulative deficit frailty model specifically designed and validated for CF lung transplant candidates will be a feasible and valid assessment tool for this population. The LT frailty index (LTFI), originating from this model, may distinguish disability directly attributable to organ failure which is likely to be reversed by timely transplantation, from irreversible frailty which reflects diminished reserve and may be associated with poor transplant outcomes. The objective of this project is to assess frailty in CF lung transplant candidates in an effort to identify patients at risk for worse outcomes and to find reversible factors contributing to frailty. The Toronto Lung Transplant program is one the largest in the world, performing more than 150 LT per year and the Toronto Adult Cystic Fibrosis Centre provides care to more than 400 adult CF patients. The Toronto LT database and the Toronto CF database were used to retrieve information concerning health issues (e.g. number and type of organs affected by disease), laboratory results (obtained as a routine evaluation of LT candidates), functional status, psychiatric problems and social support issues. More than 130 variables were analyzed and those with the best performance were used for the development of the frailty index that measures frailty in CF lung transplant candidates. During the next phase of the project, we will validate this CF-specific frailty index in lung transplant candidates from Switzerland and will assess its predictive value for outcomes after LT. The current project seeks to lay the foundaton for frailty assessment in organ transplantation. The LTFI is expected to provide patient risk stratification for adverse outcomes and to identify potentially reversible elements of frailty that could be improved through targeted interventions. This approach has the potential to transform the selection of lung transplant candidates and to improve care for CF patients internationally.
Amount: CHF 64,960
Funding type: fellowship
Funder scheme: Return CH Advanced Postdoc.Mobility
Start date: 2018-03-01
End date: 2018-10-31
Investigator: Koutsokera, Angela
Institution: University of Lausanne – LA
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Funded outputs count: 1
Funder award ID: 164734
OpenAlex ID: G5568794826