Frailty and Mortality in Kidney Transplant Recipients

Abstract

We have previously described strong associations between frailty, a measure of physiologic reserve initially described and validated in geriatrics, and early hospital readmission as well as delayed graft function. The goal of this study was to estimate its association with postkidney transplantation (post-KT) mortality. Frailty was prospectively measured in 537 KT recipients at the time of transplantation between November 2008 and August 2013. Cox proportional hazards models were adjusted for confounders using a novel approach to substantially improve model efficiency and generalizability in single-center studies. We precisely estimated the confounder coefficients using the large sample size of the Scientific Registry of Transplantation Recipients (n = 37 858) and introduced these into the single-center model, which then estimated the adjusted frailty coefficient. At 5 years, the survivals were 91.5%, 86.0% and 77.5% for nonfrail, intermediately frail and frail KT recipients, respectively. Frailty was independently associated with a 2.17-fold (95% CI: 1.01–4.65, p = 0.047) higher risk of death. In conclusion, regardless of age, frailty is a strong, independent risk factor for post-KT mortality, even after carefully adjusting for many confounders using a novel, efficient statistical approach.

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

“…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).…”

“…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).…”

Frailty and Cognitive Function in Incident Hemodialysis Patients

“…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).…”

The Importance of Prehabilitation in Liver Transplantation

“…Frailty has been found to be a more powerful predictor of functional status in the elderly than chronological age or comorbidity, with increases in an individual's frailty greatly increasing the risk of death [10,11]. Frailty is also applicable in the diminished homeostatic reserve seen in chronic illness and organ failure.…”