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Introduction: Frailty is a recognized risk factor for poor outcomes in transplant patients, but its effect on ILD patients undergoing lung transplants remains underexplored. We examined the link between frailty and key clinical outcomes in this high-risk group. Methods: Using the 2022 Nationwide Readmissions Database, we identified adult lung transplant recipients through ICD-10 procedure codes. ILD was determined by diagnosis codes, and frailty was classified using validated ICD-10 indicators. The ILD lung transplant cohort was divided into frail and non-frail groups. Outcomes included in-hospital mortality, AKI, invasive mechanical ventilation (IMV), non-home discharge, length of stay (LOS), and total hospital charges. Multivariable logistic and linear regressions were adjusted for age, sex, and comorbidity burden, hospital bed-size, and hospital teaching status.. Results: Among 9,324 lung transplant recipients, 1,521 (16.3%) had underlying ILD. Frailty was more common among ILD lung transplant patients than their non-ILD counterparts (17.5% vs. 5.8%). Frail patients were younger than their non-frail counterparts (mean age 61.5 vs. 64.8 years) and had a slightly higher proportion of females (38% vs. 35%). In adjusted analyses, frailty was independently linked to higher odds of in-hospital mortality (aOR 1.73, p=0.042), lung allograft dysfunction (aOR 2.07, p< 0.001), invasive mechanical ventilation (aOR 3.02, p< 0.001), acute kidney injury (aOR 1.44, p=0.009), and non-home discharge (aOR 2.21, p< 0.001). Frailty was also associated with longer hospital stays (β=23.3 days; p< 0.001) and higher hospital charges (β=$767,480; p< 0.001). Conclusions: Our analysis revealed that frailty is more common among ILD lung transplant recipients and is independently linked to decreased survival, increased complications, and higher healthcare utilization. Although frailty is already considered during pre-transplant evaluation, these findings emphasize the importance of recognizing ILD transplant recipients as a particularly high-risk group. Frailty-centered interventions should go beyond patient selection to include perioperative optimization and post-transplant care planning for this vulnerable population.