A New Approach to Evaluating Frailty in Solid Organ Transplantation

Read more about the project here.

Solid organ transplantation is a life-saving treatment for people with organ failure, but organ donors and recipients must be chosen carefully since transplants are risky and donor organs are so scarce. In recent years, transplant programs have been accepting older donors and recipients with more chronic health problems. It is possible that some of these patients are living with frailty, which may lead to poor outcomes after transplantation. Prior to this study, we did not know how best to measure frailty in organ transplant candidates and recipients. Without appropriate tools to measure frailty, we do not know if patients living with frailty got as much benefit from transplantation as individuals not living with frailty, or how to help patients living with frailty with organ failure have longer and better lives before and after transplantation though exercise or other treatments.

The objective of this study was to develop and test the usefulness of a new tool to measure frailty in transplant candidates for heart, lung, kidney or liver transplantation. Using the cumulative deficits model, we determined that increasing frailty is associated with less likelihood of transplant listing and higher risks for transplant waitlist death or delisting and post-transplant death.

Lianne Singer, MD, FRCPC is an Associate Professor in the Department of Medicine, with cross-appointments to the Institutes of Medical Science, and Health Policy, Management and Evaluation at the University of Toronto. Dr. Singer is Medical Director for the Toronto Lung Transplant Program, and staff physician at the University Health Network. She obtained her M.D. from the University of Toronto with residency training in Internal Medicine and Respirology. Following that, she completed a Lung and Heart-Lung Transplantation Fellowship at Stanford University and advanced training in clinical research at University of California, San Francisco. Dr. Singer’s research interests include health-related quality of life assessment in advanced lung disease and lung transplantation, frailty and sarcopenia in organ transplantation, and assessment of innovative clinical practices in lung transplantation.

Rhea Varughese, MD FRCPC is a clinical lecturer in the Department of Medicine at the University of Calgary and a respirologist with the Southern Alberta Lung Transplant Program in Calgary. She obtained her MD, followed by Internal Medicine residency and Respirology fellowship, at the University of Calgary. Afterwards, she completed her lung transplant fellowship at the Universities of Calgary and Alberta. Dr. Varughese, then, joined Dr. Singer at the University of Toronto for a research fellowship, becoming the HQP for this project. She is currently working toward a postgraduate diploma in Epidemiology at the University of London (London School of Hygiene and Tropical Medicine). Dr. Varughese’s research interests include frailty in solid organ transplantation and pulmonary diseases.