An innovative prehabilitation approach for lung transplant candidates.

Background: 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.

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.