{
  "abstract": "BackgroundThe Lung Transplant Frailty Scale (LT-FS) is a validated binary measure of frailty in lung transplant candidates. We aimed to refine the LT-FS Base and Body Composition measures by developing a three-category classification to improve clinical risk stratification with serum albumin as a more clinically practical frailty biomarker.\n\nMethodsTo develop the refined LT-FS, we applied a 4-step measure development method to a multicenter prospective cohort study of lung transplant candidates. Low albumin (<3.5 g/dL) replaced high serum C-reactive protein ([≥]10 mg/L) as the LT-FS biomarker. Cutpoints that balanced discrimination, risk prediction, and calibration were identified to define \"frail\", \"pre-frail\", and \"not frail\" categories. Next, we evaluated associations between the refined LT-FS and exercise capacity, patient-reported outcomes, and mortality using multivariate linear and Cox regression.\n\nResultsAmong 419 participants, the refined LT-FS identified a graded increase in mortality risk across frailty categories. For example, compared with candidates who were not frail, pre-frailty and frailty by the LT-FS Body Composition were associated with a 2.9-fold (HR 2.9, 95% CI 1.2-6.9) and 7-fold (HR 6.9, 95% CI 2.6-18.2) higher risk of waitlist delisting or death, respectively. Pre-frailty and frailty by LT-FS Body Composition were associated with 2-fold (HR 2.1, 95% CI 1.2-3.8) and 3.6-fold (HR 3.6, 95% CI 1.8-7.3) higher risk of mortality after transplant. Relationships with exercise capacity and patient-reported disability were less consistent.\n\nConclusionsA refined Lung Transplant Frailty Scale incorporating serum albumin demonstrates strong associations with waitlist and post-transplant mortality. The addition of a pre-frail category better captures the continuum of frailty and improves clinical risk stratification of lung transplant candidates.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Pulmonary and Critical Care, Department of Medicine, University of California San Francisco"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 24,
  "authors": [
    {
      "name": "A. Sriram"
    },
    {
      "name": "J. Christie"
    },
    {
      "name": "M. R. Anderson"
    },
    {
      "name": "L. Benvenuto"
    },
    {
      "name": "Y. Gao"
    },
    {
      "name": "S. M. Arcasoy"
    },
    {
      "name": "D. Calabrese"
    },
    {
      "name": "S. R. Hays"
    },
    {
      "name": "J. Kukreja"
    },
    {
      "name": "A. Venado"
    },
    {
      "name": "L. Betancourt"
    },
    {
      "name": "P. Gambetta"
    },
    {
      "name": "H. Scott"
    },
    {
      "name": "M. Oyster"
    },
    {
      "name": "D. Zaleski"
    },
    {
      "name": "J. Adler"
    },
    {
      "name": "L. Kalman"
    },
    {
      "name": "S. Patel"
    },
    {
      "name": "M. Tevald"
    },
    {
      "name": "K. E. Covinsky"
    },
    {
      "name": "C.-Y. Huang"
    },
    {
      "name": "J. R. Greenland"
    },
    {
      "name": "P. Katz"
    },
    {
      "affs": [
        0
      ],
      "name": "J. P. Singer"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/0bd1d4yq3jxkm.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.08.26365085",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.08.26365085v1.full",
  "id": "0bd1d4yq3jxkm",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.08.26365085v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "transplantation"
    ],
    [
      "openalex",
      "2746|Transplantation: Methods and Outcomes"
    ]
  ],
  "openalex": "W7221479600",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.08.26365085v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-08",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/0bd1d4yq3jxkm.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:37Z",
      "native_id": "10.64898/2026.10.08.26365085",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.08.26365085v2"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:transplantation",
      "subfield": "surgery"
    }
  ],
  "title": "A Refined Lung Transplant Frailty Scale Incorporating Serum Albumin Is Associated With Risk of Mortality in Lung Transplant Candidates",
  "title_text": "A Refined Lung Transplant Frailty Scale Incorporating Serum Albumin Is Associated With Risk of Mortality in Lung Transplant Candidates",
  "type": "preprint",
  "updated_at": "2026-10-30T12:20:40Z",
  "url": "https://research.draconitic.com/paper/0bd1d4yq3jxkm",
  "venue": "medRxiv",
  "versions": []
}