An innovative prehabilitation approach for lung transplant candidates.

Abstract

Frailty is a risk factor for poor outcomes in lung transplantation. Identifying the causes of frailty and addressing reversible risk factors that contribute to poor outcomes in this population is complex. To describe the results of frailty measures associated with poor outcomes and the prehabilitation plan prescribed for patients at their initial assessment for lung transplantation at our institution. We describe how a prehabilitation approach to improve function and mitigate risk factors can be incorporated into lung transplant selection committee recommendations. Data were analyzed from 186 patients seen in an outpatient physical medicine and rehabilitation (PM&R) clinic as part of their initial assessment for lung transplantation and their lung selection committee recommendations. All 186 patients who initiated evaluation for lung transplant were evaluated by PM&R during their transplant initial evaluation period. Low objective and self-reported physical function were present in the majority of patients. All patients received a multimodal prehabilitation plan to address these reversible risk factors. Prehabilitation recommendations were integrated into their lung selection committee recommendations. A comprehensive physiatric assessment for the purpose of identifying reversible risk factors for poor outcomes such as frailty and prescribing interventions to improve function is a feasible addition to the lung transplant evaluation process. This patient population has high prehabilitation needs.