Relationship between pre-transplant physical function and outcomes after kidney transplant

Abstract

Background Performance-based measures of physical function predict morbidity following non-transplant surgery. Study objectives were to determine whether physical function predicts outcomes after kidney transplant and assess how physical function changes post-transplant. Methods We conducted a prospective study involving living donor kidney transplants recipients at our center 5/2012 to 2/2014. Physical function was measured using the Short Physical Performance Battery (SPPB) (balance, chair stands, gait speed) and grip strength testing. Initial length of stay (LOS), 30-day rehospitalizations, allograft function and quality of life (QOL) were assessed. Results The majority of the 140 patients in our cohort had excellent pre-transplant physical function. In general, balance scores were more predictive of post-transplant outcomes than the SPPB. Decreased pre-transplant balance was independently associated with longer LOS and increased rehospitalizations but not with post-transplant QOL. 35% of patients experienced a clinically meaningful (≥ 1.0 m/s) improvement in gait speed four months post-transplant. Conclusions Decreased physical function may be associated with longer LOS and rehospitalizations following kidney transplant. Further studies are needed to confirm this association. The lack of relationship between pre-transplant gait speed and outcomes in our cohort may represent a ceiling effect. More comprehensive measures, including balance testing, may be required for risk stratification.

Pre-Kidney Transplant Lower Extremity Impairment and Post-Kidney Transplant Mortality

“…However, even the younger‐impaired KT recipients experienced a 2.34‐fold increased risk of mortality compared to their unimpaired counterparts. Consistent with recent findings on SPPB performance and length of stay, performance on the balance portion had the single strongest association with mortality of all the individual SPPB components . Finally, SPPB impairment performed similarly to frailty with regard to strength of association with (aHR 2.30 vs. 2.17) and prediction of (C‐statistic 0.76 vs. 0.76) mortality.…”

“Early” and “Late” Hospital readmissions in the first year after kidney transplant at a single center

“…Appreciation of the impact of recipient demographics and characteristics including pre‐transplant hospitalization history and KT LOS upon readmission patterns are relevant to inform payer contracts, patient and family expectations, perioperative care coordination, and institutional resources dedicated to optimize recipient recovery after transplant. Pre‐transplant frailty and physical function have been correlated with increased transplant LOS and early readmission after KT; however, it remains to be seen if pre‐transplant interventions to impact these factors will enhance post‐transplant outcomes.…”

Pretransplant transcriptomic signature in peripheral blood predicts early acute rejection

“…Therefore, our gene signature is relevant and may allow the identification of patients who could benefit the most from induction therapy or increased maintenance immunosuppression. This assay may also allow identification of patients at low risk for EAR, where surveillance biopsies may be avoided (43)(44)(45).…”