Comprehensive review: Frailty in pancreas transplant candidates and recipients

Parsons, Ronald F.; Tantisattamo, Ekamol; Cheungpasitporn, Wisit; Basu, Arpita; Lu, Yee; Lentine, Krista L.; Woodside, Kenneth J.; Singh, Neeraj; Scalea, Joseph R.; Alhamad, Tarek; Dunn, Ty B.; Rivera, Franco H Cabeza; Parajuli, Sandesh; Pavlakis, Martha; Cooper, Matthew

doi:10.1111/ctr.14899

Cited by 7 publications

(6 citation statements)

References 169 publications

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Section: Discussionmentioning

confidence: 99%

“…Parsons et al, in their systematic review and meta-analysis, investigated the phenomenon of frailty in candidates for kidney and pancreas transplantation [23]. The authors found that the risk of frailty increases with age and is associated with a lower chance of being listed for transplantation, higher mortality on the waiting list, and reduced access to SPKT among adult candidates [23,24]. Furthermore, frailty is associated with adverse transplant outcomes, such as surgical complications, delayed graft function, postoperative delirium, poor tolerance of immunosuppression, and higher mortality [24].…”

Section: Discussionmentioning

confidence: 99%

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Nutritional Status of Kidney and Pancreas Transplant Candidates - Experience of the One Polish Transplant Center (Observational Study)

Kędzierska-Kapuza¹,

Niewiński²,

Durlik³

et al. 2023

Preprint

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Pancreas transplantation is a high-risk operation that requires significant skill and expertise from the surgeons and the postoperative care team. Prior to candidate qualification, all contraindications to this procedure must be excluded. The use of screening tools and nutritional assessment aims to emphasize the importance of accurately diagnosing nutritional status in order to implement early nutritional interventions and reduce complications associated with malnutrition. This plays a crucial role in improving postoperative outcomes for patients undergoing pancreas and/or kidney transplantation. Objective: The aim of this study was to analyze the parameters of nutritional status in patients eligible for kidney transplantation and kidney with pancreas transplantation. Methods: The study analyzed the database of hospitalized patients in our Center from 2020 to 2023 to identify preoperative parameters of nutritional status in patients eligible for kidney transplantation (Ktx) and kidney with pancreas transplantation (SPKTx). Participants: A total of 59 patients participated in the study, who were candidates for kidney transplantation (23, including 11 females and 12 males) or kidney with pancreas transplantation (36, including 24 females and 12 males). Parameters examined included: Onoder's Prognostic Nutritional Index (PNIO), Nutrition Risk Index (NRI), ideal body weight (IBW) calculated using the Lorenz formula, and the neutrophil-to-lymphocyte ratio (NLR). All patients admitted to the clinic underwent the NRS-2002 clinical assessment scale for nutritional status. Results: Upon analyzing the obtained results, it was found that BMI was not a good differentiating parameter for the studied groups. The PNIO index also insufficiently differentiated the studied groups, and similarly, the NRI index was a weak differentiating parameter. The NRS-2002 index and albumin level were the best indicators of differences between the groups. In the group of transplantation candidates, several parameters indicated that patients in the Ktx group (kidney transplantation candidates) had better nutritional status than SPKtx candidates (kidney with pancreas transplantation candidates), despite the former group being older patients. Conclusion: It seems that more effort should be made to start a proper nutrition plan for SPKTx (and especially peritoneal dialysis) patients. Regular assessment of nutrition status should be performed. SPKtx patients in the perioperative period should receive parenteral nutrition and, as soon as their general condition allows it, enteral nutrition, taking into account the caloric and protein needs

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Nutritional Status of Kidney and Pancreas Transplant Candidates - Experience of the One Polish Transplant Center (Observational Study)

Kędzierska-Kapuza¹,

Niewiński²,

Durlik³

et al. 2023

Preprint

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“…Similarly, to the best of our knowledge, there are no studies assessing the effect of frailty directly in pancreas transplant recipients in the perioperative period. In one study presented as an abstract in the 2018 American Transplant Congress scientific meeting by Parsons et al, 95 among 100 pancreas transplant recipients, authors found that sarcopenia predicts more resource utilization focused on readmission days in the first year after transplant.…”

Section: Introductionmentioning

confidence: 99%

Frailty in Pancreas Transplantation

et al. 2021

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INTRODUCTIONIn recent years, frailty has received increasing attention in various areas of medicine. [1][2][3] Although various previous definitions of frailty were similar to the definition of disability, comorbidities, or advanced age, frailty is not synonymous with those conditions. 4 Geriatricians define frailty as a biologic syndrome of decreased reserve and resistance to stressors that results from cumulative declines across multiple physiologic systems, leading to vulnerability to adverse outcomes. 4 In the absence of a gold-standard definition of frailty, it has been operationally defined by Fried et al 4 as meeting 3 out of 5 phenotypic criteria indicating compromised energetic: low grip strength, low energy, slowed walking speed, low physical activity, and unintentional weight loss. 5 Frailty is a common problem in various solid organ transplant candidates who are in the process of being listed for a transplant, as well as after transplantation. [6][7][8][9][10] Even after adjusting for the multiple confounding factors, frail patients are less likely to be listed for kidney transplantation, less likely to get a transplant, and more likely to die on the waitlist. 10 Other complications of frailty include increased length of hospital stay, readmission, delayed graft function, and many more (Figure 1). 11 Patients with diabetes or chronic kidney disease (CKD) are known to be at increased risk of being frail. 12,13 Risk factors for frailty include older age, low education level, intellectual disability, depression, unmarried status, current cigarette smoker, use of postmenopausal hormone therapy, and being African American. [14][15][16][17][18] Transplant programs use different tools and criteria to assess frailty among possible organ recipients. In a recent survey from the United States, among 133 kidney transplant programs that responded to the survey, McAdams-DeMarco et al 11 found 19 different tools/criteria used by kidney transplant programs to assess for frailty-these are summarized in Table 1.Pancreas transplant recipients are in a unique situation, where all patients would have diabetes for a prolonged period. In addition, the majority of them would also have CKD, requiring both pancreas and kidney transplantation. Here, we review clinically relevant information about frailty, including prevalence, risk factors, assessment tools, and impacts, as it relates to pancreas transplant recipients, both

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“…

F railty prevalence among solid organ transplant candidates is higher than in the general population and is present at earlier ages. [1][2][3][4][5] Recently, frailty has received increasing attention in both medical and surgical fields as a physiologic syndrome that can be associated with numerous poor medical and surgical outcomes. [6][7][8] Although there is no goldstandard frailty definition, it has been operationally defined by Fried et al as meeting 3 of 5 phenotypic criteria indicating compromised energetics: low grip strength, low energy, slowed walking speed, low physical activity, and unintentional weight loss.

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mentioning

confidence: 99%

Analysis of Individual Components of Frailty in Simultaneous Pancreas and Kidney, and Solitary Pancreas Transplant Recipients

Parajuli,

Odorico,

Breyer

et al. 2023

Transplantation Direct

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Backgrounds: It is not known which of the 5 components of the Fried frailty score have the most predictive value for outcomes in simultaneous pancreas-kidney transplant (SPK) and solitary pancreas transplant (SPT) recipients. Methods: In this study, we sought to investigate the association between pretransplant overall frailty and individual frailty components, with posttransplant outcomes among SPK and SPT recipients. Outcomes of interest were length of stay, kidney delayed graft function (K-DGF), readmission within 30 d after discharge, cardiovascular events, acute rejection, pancreas death-censored graft failure (DCGF), kidney DCGF, and death. Results: Of the individual frailty components among SPK (n = 113), only slow walk time was associated with an increased risk of mortality (adjusted odds ratio [aOR]: 4.99; P = 0.03). Among SPT (n = 49), higher sum frailty scores (coefficient correlation 0.29; P = 0.04) and weight loss (coefficient correlation = 0.30; P = 0.03) were associated with prolonged length of stay. Similarly, weight loss among SPT was associated with an increased risk of DCGF (aOR: 4.34; P = 0.049). Low grip strength was strongly associated with an increased risk of early readmission (aOR: 13.08; P = 0.008). Conclusions: We found that not all components of frailty contribute equally to predicting outcomes. Objective measurements of slow walk time, unintentional weight loss, and low grip strength were found to be associated with less optimal outcomes in pancreas transplant recipients. Targeted interventions may improve posttransplant outcomes.

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Comprehensive review: Frailty in pancreas transplant candidates and recipients

Cited by 7 publications

References 169 publications

Nutritional Status of Kidney and Pancreas Transplant Candidates - Experience of the One Polish Transplant Center (Observational Study)

Nutritional Status of Kidney and Pancreas Transplant Candidates - Experience of the One Polish Transplant Center (Observational Study)

Frailty in Pancreas Transplantation

Analysis of Individual Components of Frailty in Simultaneous Pancreas and Kidney, and Solitary Pancreas Transplant Recipients

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