Prevalence of frailty among kidney transplant candidates and recipients in the United States: Estimates from a National Registry and Multicenter Cohort Study

Abstract

Frailty, a measure of physiologic reserve, is associated with poor outcomes and mortality among kidney transplant (KT) candidates and recipients. There are no national estimates of frailty in this population, which may help patient counseling and resource allocation at transplant centers. We studied 4616 KT candidates and 1763 recipients in our multicenter prospective cohort of frailty from 2008‐2018 with Fried frailty measurements. Using Scientific Registry of Transplant Recipients (SRTR) data (KT candidates = 560 143 and recipients = 243 508), we projected the national prevalence of frailty (for KT candidates and recipients separately) using standardization through inverse probability weighting, accounting for candidate/recipient, donor, and transplant factors. In our multicenter cohort, 13.3% of KT candidates were frail at evaluation; 8.2% of LDKT recipients and 17.8% of DDKT recipients were frail at transplantation. Projected nationally, our modeling strategy estimated 91 738 KT candidates or 16.4% (95% confidence interval [CI] 14.4%‐18.4%) of all KT candidates during the study period were frail, and that 34 822 KT recipients or 14.3% (95% CI 12.3%‐16.3%) of all KT recipients were frail (LDKT = 8.2%; DDKT = 17.8%). Given the estimated national prevalence of frailty, transplant programs should consider assessing the condition during KT evaluation to improve patient counseling and resource allocation along with identification of recipients at risk for poor outcomes.

Prevalence of Frailty in Patients Referred to the Kidney Transplant Waitlist

“…In this prospective cohort of kidney transplant waitlist candidates, we assessed three clinical assessment tools, two of which have not previously been studied in this population (23). We described the prevalence of frailty, identified characteristics associated with frailty, and assessed agreement between all three frailty definitions.…”

Frailty Prevalence in Younger End-Stage Kidney Disease Patients Undergoing Dialysis and Transplantation

“…This study is limited by the dialysis and transplant centers included; though results are likely reflective of the regions these centers represent, frailty prevalence is expected to vary by geographic location across the USA, as is observed among community-dwelling older adults [43, 47]. Additionally, these data are cross-sectional in nature; these are 3 different cohorts representing distinct stages across the ESKD care continuum, and as such, results only apply to patients at a particular stage.…”

Early effects of first‐line treatment with anti‐interleukin‐6 receptor antibody tocilizumab for chronic active antibody‐mediated rejection in kidney transplantation

“…Indeed, the cumulative effect of multiple lines of therapy may potentially impact safety, particularly considering chronic treatments such as TCZ 12,13 . In addition, the continuous change in the demography of recipients toward an older age and a frail profile [14][15][16] may considerably influence the risk/benefit balance of increasing long-term immunosuppressive load. In this context avoidance of unnecessary treatments is mandatory.…”