Frailty and Delayed Graft Function in Kidney Transplant Recipients

Garonzik-Wang, Jacqueline; Govindan, Priyanka; Grinnan, Jack; Liu, Minghao; Ali, Hassan; Chakraborty, Anindita; Jain, Vaibhav; Ros, R. Lorie; James, Nathan T.; Kucirka, Lauren M.; Hall, Erin C.; Berger, Judith; Montgomery, Robert A.; Desai, Niraj M.; Dagher, Nabil N.; Sonnenday, Christopher J.; Englesbe, Michael J.; Makary, Martin A.; Walston, Jeremy D.; Segev, Dorry L.

doi:10.1001/archsurg.2011.1229

Cited by 216 publications

(199 citation statements)

References 16 publications

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“…Following on this work, others found that preoperative frailty assessment predicted perioperative complications and mortality following cardiac and abdominal surgery above and beyond existing risk stratification tools (12,13,(51)(52)(53). Most recently, these measures have been shown to predict death in liver transplant candidates as well as delayed graft function and death in kidney transplant recipients (15)(16)(17).…”

Section: Discussionmentioning

confidence: 93%

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Frailty Phenotypes, Disability, and Outcomes in Adult Candidates for Lung Transplantation

Singer¹,

Diamond²,

Gries

et al. 2015

Am J Respir Crit Care Med

187

216

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Rationale: Frailty is associated with morbidity and mortality in abdominal organ transplantation but has not been examined in lung transplantation.Objectives: To examine the construct and predictive validity of frailty phenotypes in lung transplant candidates.Methods: In a multicenter prospective cohort, we measured frailty with the Fried Frailty Phenotype (FFP) and Short Physical Performance Battery (SPPB). We evaluated construct validity through comparisons with conceptually related factors. In a nested case-control study of frail and nonfrail subjects, we measured serum IL-6, tumor necrosis factor receptor 1, insulin-like growth factor I, and leptin. We estimated the association between frailty and disability using the Lung Transplant Valued Life Activities disability scale. We estimated the association between frailty and risk of delisting or death before transplant using multivariate logistic and Cox models, respectively.Measurements and Main Results: Of 395 subjects, 354 completed FFP assessments and 262 completed SPPB assessments; 28% were frail by FFP (95% confidence interval [CI], 24-33%) and 10% based on the SPPB (95% CI, 7-14%). By either measure, frailty correlated more strongly with exercise capacity and grip strength than with lung function. Frail subjects tended to have higher plasma IL-6 and tumor necrosis factor receptor 1 and lower insulin-like growth factor I and leptin. Frailty by either measure was associated with greater disability. After adjusting for age, sex, diagnosis, and transplant center, both FFP and SPPB were associated with increased risk of delisting or death before lung transplant. For every 1-point worsening in score, hazard ratios were 1.30 (95% CI, 1.01-1.67) for FFP and 1.53 (95% CI, 1.19-1.59) for SPPB.Conclusions: Frailty is prevalent among lung transplant candidates and is independently associated with greater disability and an increased risk of delisting or death.Keywords: biomarker; body composition; disability; frailty; lung transplantation Author Contributions: J.P.S., J.M.D., C.J.G., P.D.B., P.P.K., J.D.C., and D.J.L. made substantial contributions to the conception and design of the work; J.P.S. wrote the first draft of the manuscript; and J.P.S., J

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Section: Discussionmentioning

confidence: 93%

“…Drawing from the geriatrics experience, frailty has become recognized more recently as a risk factor for poor outcomes in solid organ transplantation. Specifically, frailty has been found to be associated with delayed graft function and mortality in kidney transplant recipients and waitlist mortality in liver transplant candidates (15)(16)(17).…”

mentioning

confidence: 99%

Frailty Phenotypes, Disability, and Outcomes in Adult Candidates for Lung Transplantation

Singer¹,

Diamond²,

Gries

et al. 2015

Am J Respir Crit Care Med

187

216

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“…At enrollment, frailty was measured as defined and validated by Fried in older adults (3,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) and by our group in ESRD and kidney transplantation (5,6,(28)(29)(30)(31). Frailty was based on five components: shrinking (selfreport of unintentional weight loss of .10 lb in the past year based on dry weight), weakness (grip strength below an established cutoff based on sex and BMI), exhaustion (self-report), low activity (kilocalories per week below an established cutoff), and slowed walking speed (walking time of 15 ft below an established cutoff by sex and height) (3).…”

Section: Frailtymentioning

confidence: 99%

Frailty and Cognitive Function in Incident Hemodialysis Patients

McAdams‐DeMarco¹,

Tan²,

Salter³

et al. 2015

Clinical Journal of the American Society of Nephrology

162

136

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Background and objectives Patients of all ages undergoing hemodialysis (HD) have a high prevalence of cognitive impairment and worse cognitive function than healthy controls, and those with dementia are at high risk of death. Frailty has been associated with poor cognitive function in older adults without kidney disease. We hypothesized that frailty might also be associated with poor cognitive function in adults of all ages undergoing HD.Design, setting, participants, & measurements At HD initiation, 324 adults enrolled (November 2008 to July 2012) in a longitudinal cohort study (Predictors of Arrhythmic and Cardiovascular Risk in ESRD) were classified into three groups (frail, intermediately frail, and nonfrail) based on the Fried frailty phenotype. Global cognitive function (3MS) and speed/attention (Trail Making Tests A and B [TMTA and TMTB, respectively]) were assessed at cohort entry and 1-year follow-up. Associations between frailty and cognitive function (at cohort entry and 1-year follow-up) were evaluated in adjusted (for sex, age, race, body mass index, education, depression and comorbidity at baseline) linear (3MS, TMTA) and Tobit (TMTB) regression models.Results At cohort entry, the mean age was 54.8 years (SD 13.3), 56.5% were men, and 72.8% were black. The prevalence of frailty and intermediate frailty were 34.0% and 37.7%, respectively. The mean 3MS was 89.8 (SD 7.6), TMTA was 55.4 (SD 29), and TMTB was 161 (SD 83). Frailty was independently associated with lower cognitive function at cohort entry for all three measures (3MS: 22.4 points; 95% confidence interval [95% CI], 24.2 to 20.5; P=0.01; TMTA: 12.1 seconds; 95% CI, 4.7 to 19.4; P,0.001; and TMTB: 33.2 seconds; 95% CI, 9.9 to 56.4; P=0.01; all tests for trend, P,0.001) and with worse 3MS at 1-year follow-up (22.8 points; 95% CI, 25.4 to 20.2; P=0.03). ConclusionsIn adult incident HD patients, frailty is associated with worse cognitive function, particularly global cognitive function (3MS).

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“…Functional status is one of the critical criteria for selecting candidates for kidney transplantation since poor functional status or frailty in ESRD patients are associated with unfavorable transplant outcomes including re-hospitalization, poor renal allograft outcomes, and decreased patient survivals [13][14][15]. From observation, ESRD patients with a good functional status tend to do well and have a short recovery period after kidney transplantation.…”

Section: Intervention During Pre-transplant Periodmentioning

confidence: 99%

Challenging Weight Gain and Obesity: An Opportunity for Dietary Management after Successful Kidney Transplantation

Tantisattamo¹

2017

AOWMC

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Several factors contributing to post-transplant weight gain and obesity may occur during pre-, peri-, and/or post-transplant periods. The main factors are summarized in Figure 1. Pre-transplant periodDuring the pre-transplant period, there are several factors related to advanced CKD and ESRD that potentially increase the risk for post-transplant weight gain and obesity. These main risk factors include:Pre-transplant obesity: Data from a single kidney transplant center revealed that around one-third of ESRD patients were AbstractWeight gain and obesity are common after kidney transplantation. Several known risk factors for obesity in non-transplant population remain to be the important determining factors for obesity in kidney transplant recipients. In addition, some factors related to kidney transplantation contribute to post-transplant weight gain and obesity. These factors can occur during pre-, peri-, and/or post-transplant periods. During pre-transplant period, underlying conditions such as metabolic syndrome place the patients at risk for obesity after kidney transplantation. Positive fluid balance during peri-transplant period transiently causes posttransplant weight gain. Post-operative pain from surgical wounds limits physical activities and prevents weight loss especially in patients with pre-transplant obesity. Immunologic and non-immunologic factors during post-transplant period can become barriers to lose weight or even perpetuate obesity. Among of these factors, inappropriate dietary and nutrition management plays an important role in post-transplant weight gain and obesity. Apart from the dietary aspect, there are other factors contributing to post-transplant weight gain and obesity and these include the individual patient and their family, kidney transplant team through education and social aspects. Therefore, a multidisciplinary approach is required to prevent post-transplant weight gain and obesity.

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Frailty and Delayed Graft Function in Kidney Transplant Recipients

Cited by 216 publications

References 16 publications

Frailty Phenotypes, Disability, and Outcomes in Adult Candidates for Lung Transplantation

Frailty Phenotypes, Disability, and Outcomes in Adult Candidates for Lung Transplantation

Frailty and Cognitive Function in Incident Hemodialysis Patients

Challenging Weight Gain and Obesity: An Opportunity for Dietary Management after Successful Kidney Transplantation

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