Frailty and prehabilitation in lung transplant candidates: A cross-sectional UK survey of assessment, provision and barriers

Abstract

Objectives: Frailty is a multifactorial state of reduced physiological reserve and increased vulnerability, common in lung transplantation (LTx) candidates and associated with morbidity and mortality. There is no consensus on appropriate frailty instruments or optimal prehabilitation. Aims were to: (1) identify frailty measures in UK adult LTx candidates, (2) describe prescribed prehabilitation interventions, and (3) explore barriers to prehabilitation. Methods: An anonymous online QualtricsXM survey was circulated via UK LTx coordinators and social media. Eligible respondents were professionals contributing to adult pre-operative assessment and listing decisions. Results were analysed using SPSS. Results: Thirty-one respondents met criteria, representing all five UK LTx centres. Frailty was always assessed by 58.1% and sometimes by 25.8%, though comprehensive measurement tools were rarely used. Functional tools included the Short Physical Performance Battery and sit-to-stand tests. Assessments occurred pre-listing and during waitlisting. Frailty was discussed at all listing meetings and influenced transplant suitability. Outpatient prehabilitation included face to face, telephone, and local referrals, targeting exercise, nutrition, and psychosocial needs. Reported barriers were travel, funding, and limited space. Conclusion: UK lung transplant services conceptually recognise frailty as multidimensional and clinically important, but operationally rely on pragmatic, largely physical proxy measures. Prehabilitation provision is variable and often externally delivered constrained by system-level resource and access barriers.