Table 1:
Summary of recent studies of frailty and outcomes after kidney transplantation, adopted from 42.
| Reference, year | Study design and Participants | Frailty measure, timing and prevalence | Outcome/s associated with frailty | Other key findings | Study limitations |
|---|---|---|---|---|---|
| Garonzik-Wang, Arch Surg 201248 | Prospective cohort Single center 12/2008 –4/2010 N=183 (35% LDKTx) |
Fried Frailty Score 3–5 at the time of
admission for transplant Frailty at KTx: 25.1% |
DGF: 30% vs 15% in frail vs non-frail, aHR 1.131.963.36 | Deceased donor serum creatinine level and cold ischemia time was also associated with DGF. | Single center Observational Small sample size |
| McAdams-Demarco, AJT 201311 | Retrospective cohort Single center 12/2008 –12/2012 N=383 (39% LDKTx) |
Fried Frailty Score 3–5 at the time of
admission for transplant Frailty at KTx: 18.8% |
Early (within 30 days) hospital readmission (EHR): 46% vs 28% in frail vs non-frail, aRR 1.181.61 2.19. | Frailty improved EHR risk prediction by improving the area under the ROC curve and the net reclassification index. | Single center Observational Frail sample included more men (71% vs 58%, P=0.046) |
| McAdams-Demarco, JAGS 201533 | Prospective cohort Single center 12/2008 –3/2014 N=349 (37% LDKTx) Cohort overlaps with other McAdams studies |
Fried Frailty Score 3–5 at the time of
admission for transplant Frailty at KTx: 19.8% |
Change in frailty score after KTx: The only risk factor associated with improvement in frailty score was pre-KT frailty (aHR 1.712.553.82). | Pre-KT frailty status, diabetes mellitus, and DGF were independently associated with long-term changes in frailty score. | Single center Observational Short follow up |
| McAdams-Demarco Transplantation 201725 | Prospective cohort Single center N=663 12/2008–8/2015 Cohort overlaps with other McAdams studies |
Fried Frailty Score 3–5 at the time of
admission for transplant Frailty at KTx: 19.5% |
3 yr death: Associated with combinations of exhaustion and slowed walking speed (HR 1.172.435.03) and poor grip strength, exhaustion, and slowed walking speed (HR 1.142.615.97). | Frailty associated with older age (adjusted prevalence ratio aPR 1.212.224.07) IADL disability (1.723.226.06), depression (3.0211.3131.82), less than high school education (1.303.107.36), and low HRQOL (1.483.719.31). | Single center Observational |
| McAdams-Demarco, Transplantation 201834 | Prospective cohort 2 US centers N=443 (34.8% LDKTx) 5/2014–5/2017 Updated cohort from prior McAdams studies. |
Fried Frailty Score 3–5 at the time of admission for transplant | HRQOL: physical and kidney-disease specific
elements are worse in frail recipients, but mental elements are
similar. HRQOL change at 3 months post-KTx: • change in physical element 1.35 vs 0.34 points per month in frail vs non-frail • kidney disease-specific: 3.75 vs 2.41 points per month in frail vs non-frail |
Observational Single instrument Short follow-up Unclear testing protocol | |
| Nastasi, Transplantation 201827 | Prospective cohort 2 US centers N=719 Cohort overlaps with prior McAdams study |
Fried Frailty Score 3–5 at the time of
admission for transplant Lower extremity functional impairment using Short Physical Performance Battery (SPPB) at the time of admission for transplant |
Death: associated with lower extremity functional impairment (aHR 1.122.304.74), after adjustment of other risk factors including Fried Frailty Score. | Observational | |
| Alhamad ATC abstract 201626 | Retrospective cohort Single center N=383 2000–2014 |
6 minute walk test (6MWT) <1000ft | Graft failure & death: 6MWT <1000ft not associated with graft failure or patient death at 1, 3, and 5 years. At 10 years, short 6MWT <1000ft associated with graft failure (aHR 1.84.29.6) but not death. | Single center Observational | |
| Lynch, Ann Surgery 201622 | Registry based: linkage of USRDS &
Medicare claims. N=37,623 (Medicare-insured) 1/2000 –12/2010 |
Hospitalization days within 1 year before
KTx: 0: 51% 1–7: 25% 8–14: 11% 5+: 13% |
Admission in 1 yr after KTx: grade association
with pre-KTx hospitalization (aHR 1.171.281.70).
3yr death: grade association with pre-KTx hospitalization (aHR 1.201.421.70). 3yr graft loss: grade association with pre-KTx hospitalization (aHR 1.151.301.44). |
Hospitalization associated with female, prior
KTx recipients, diabetic, CHF, atherosclerotic vascular disease, and
COPD. Pre-KTx hospitalization associated with greater length of stay during transplant admission and greater service needs at discharge. |
Observational Registry data Medicare only |
| Lynch, AJT 20179 | Registry based: linkage of USRDS &
Medicare. N=51,111 (wait-listed KTx candidates) 1/2000–12/2010 |
Hospitalization days in the 1st year of
wait-list: 0: 47% 1–7: 23% 8–14: 12% 15+: 19% |
Death on waitlist: grade association with
pre-KTx hospitalization (aHR
1.241.492.07). Survival benefit of KTx vs staying on waitlist: Significant across all grades of pre-KTx hospitalization. Predictive model using admissions while on waitlist alone had higher accuracy for post-listing mortality than EPTS. |
Hospitalization associated w same risk factors as the prior Lynch study. | Observational Registry data Medicare only |
| Terjimanian, Clin Transplant 201726 | Retrospective cohort Single center 2005 – 2014 N=158 |
Morphometric age: calculated through analytic morphomics on CT scan within 1 yr pre-KTx | Death: associated with morphometric age (HR 1.031.061.08 per year) but not chronologic age. | In chronologically oldest patients, those with younger morphometric age had greater survival rates. | Observational Single center Small sample size single center Surrogate measure not established in ESRD |
CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; EPTS, expected post-transplant survival; KTx, kidney transplant; LDKTx, living donor kidney transplant; SR, self-report; PF, physical function; USRDS, United States Renal Data System; aRR, adjusted risk ratio; aHR, adjusted hazard ratio