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An interdisciplinary approach to the older transplant patient

strategies for improving clinical outcomes

Schaenman, Joannaa; Goldwater, Deenab; Malinis, Maricarc

Current Opinion in Organ Transplantation: August 2019 - Volume 24 - Issue 4 - p 504–510
doi: 10.1097/MOT.0000000000000662
INFECTIOUS DISEASES: Edited by Emily Blodget
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Purpose of review To describe the latest investigations into the role of frailty and assessment of other aging-related issues in the solid organ transplant candidate and recipient. This information is relevant for all involved in the care of transplant patients, but is especially relevant in infectious diseases, given the increased burden of infection seen in older and frailer patients.

Recent findings The Fried Frailty Phenotype (FFP) and Short Performance Physical Battery (SPPB) are well validated tools for measuring frailty in older adults. Recently, these frailty tools have also been used to predict a range of clinical outcomes in adults with endstage organ disease undergoing advanced therapies including mechanical circulatory device (MCSD) or transplantation including death on the waiting list, length of hospital stay, need for readmission, infection, and death. Frailty may also be estimated by chart review and comorbidity assessment. Other aging-related evaluations of interest are cognitive function, sarcopenia, and nutritional status. The strength of association for each tool varies by the type of end organ disease, although there are many findings in common across organ types.

Summary As trends in the aging of the population continue to impact transplant and MCSD candidates and recipients, it is increasingly important for providers to be cognizant of the methods for assessment of aging-associated dysfunction including frailty and sarcopenia.

aDivision of Infectious Diseases

bDivisions of Geriatrics and Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California

cSection of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA

Correspondence to Joanna Schaenman, Division of Infectious Diseases, Department of Medicine, David Geffen School of medicine at UCLA, CHS 37-121, Los Angeles, CA 90095, USA. Tel: +1 310 825 7225; e-mail: jschaenman@mednet.ucla.edu

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