Frailty in Pancreas Transplantation

Abstract

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

Comprehensive review: Frailty in pancreas transplant candidates and recipients

“…Quality of life has been shown to improve following pancreas transplantation to a greater extent than in kidney transplant alone, however, the impact of frailty on this effect has not been described. 119 Compared to patients who underwent kidney transplant alone, SPK recipients reported better values on a Kidney Disease and Quality of Life Short Form 120,121 Patients with type 1 diabetes who underwent SPK have reported improved quality of life on specific metrics around kidney disease and diabetes compared with those on the waitlist for SPK. 122…”

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

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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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