Guideline Video

Guideline Resources

  • Assessing and Addressing Frailty in Candidates for Lung Transplantation
  • International Society for Heart and Lung Transplantation
  • August 20, 2026
  • Summary
  • Full-text

Video Transcription

Just published August 20th, 2026, the International Society for Heart and Lung Transplantation’s newest consensus statement on Assessing and Addressing Frailty in Candidates for Lung Transplantation.

The document for the selection of lung transplant candidates recommends frailty assessment as part of a comprehensive candidacy evaluation and addresses practical and logistical issues regarding the assessment and management of frailty in lung transplant candidates.

In today’s rapid update, we’ll just be going over a summary of recommendations so for the full consensus statement, make sure to check it out on guidelinecentral.com

Let’s get started. 

Starting with the section on Defining Frailty

  • Pre-transplant physical frailty attributable to advanced lung disease may reverse after lung transplantation
  • Programs should consider potential reversibility of frailty and program capacity to support recovery when selecting candidates with frailty for lung transplantation. 

Next the section on Choosing a Measure(s) to Assess Frailty in Lung Transplant Candidates

  • The consensus statement recommends that objective frailty measures be incorporated into the multidisciplinary candidate evaluation and selection process. 
  • The consensus statement recommends that programs select a measure that has been rigorously studied in a lung transplant population and supports the reliable capture and use of data to inform clinical decision-making.
  • The consensus statement recommends that programs identify programmatic goals prior to selecting and implementing a frailty assessment instrument.
  • The consensus statement recommends that transplant programs incorporate results from standardized frailty assessments into discussions with individual patients and their caregivers to help set care-related expectations. 
  • The consensus statement recommends that programs track relevant findings and outcomes to evaluate whether assessments are achieving the stated programmatic goals.
  • The consensus statement recommends that all transplant programs perform frailty screening on all transplant candidates. 
  • Selective frailty screening may be considered if the frailty assessments are used exclusively for institutional resource planning.
  • The consensus statement recommends that hospitalized lung transplant candidates have a frailty assessment upon their initial admission or initial lung transplant consultation to guide intervention strategies, including discussions of extracorporeal membrane oxygenation bridge to transplantation. 
  • The consensus statement recommends development of a frailty measure specific for use in critically ill lung transplant candidates. 

On to the section on What to Do When Frailty is Identified 

  • All lung transplant candidates, including those on mechanical support, should be considered for exercise interventions, in parallel with the evaluation process. 
  • The recommended frequency for exercise interventions is at least 3 sessions per week, but daily exercise is recommended for all lung transplant candidates. 
  • The recommended exercise interventions for prehabilitation should include lower limb resistance/strength training and endurance as tolerated.
  • Home-based and virtual exercise interventions are acceptable alternatives to center-based programs, depending on the candidate’s situation and resources of the transplant center.
  • The consensus statement recommends that individualized nutritional supplementation be used alongside exercise interventions to reverse sarcopenia and prevent or improve frailty in lung transplant candidates. 
  • The consensus statement recommends that all candidates be screened for malnutrition and have nutritional status monitored throughout the continuum of care.
  • Frailty assessments should be repeated at intervals when their results are likely to inform or influence clinical team decision-making.
  • Assessment of frailty after lung transplantation should be performed using similar measures and managed using similar interventions to the pretransplant approach.
  • Changes in clinical status after lung transplantation, such as the development of chronic lung allograft dysfunction, may warrant repeat frailty assessments and interventions to improve symptoms and quality of life.

And there you have it. Make sure to check out the full consensus statement from the International Society for Heart and Lung Transplantation and other related clinical decision support tools at guidelinecentral.com.

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