MO984: Increased Mortality After Kidney Transplantation in Mildly Frail Recipients: Need for Pretransplant Intervention. (3rd May 2022)

• Record Type: Journal Article
• Authors: Pascual, Julio; Arias Cabrales, Carlos; Redondo Pachon, Dolores; Burballa, Carla; Buxeda, Anna; Bach, Anna; Faura, Anna; Marco, Esther; Rodriguez, Leocadio; Crespo, Marta; José Pérez-Saéz, María
• Is Part Of: Nephrology dialysis transplantation. Volume 37(2022)Supplement 3
• Publication Date: 2022-05-03
• Subjects: Nephrology -- Periodicals; Hemodialysis -- Periodicals; Kidneys -- Transplantation -- Periodicals; Hemodialysis; Kidneys -- Transplantation; Nephrology; Periodicals; 616.61
• DOI: 10.1093/ndt/gfac087.042
• Languages: English
• ISSNs: 0931-0509

Abstract

Abstract: BACKGROUND AND AIMS: Frailty is associated with a higher rate of complications and mortality after kidney transplantation (KT). Physical frailty phenotype (PFP) is the most used frailty instrument among KT recipients, it comprises five criteria and classifies patients as frail if they have ≥3. We aimed to determine the impact of scoring 1 PFP criterion (mild frailty) on transplant outcomes. METHOD: We have prospectively followed 449 KT candidates evaluated for frailty by PFP at the time of inclusion on the KT waiting list. Patients were classified as follows: 0, robust; 1, pre-frail-1; 2, pre-frail-2; and ≥3, frail. A prospective longitudinal study was performed in all patients in the cohort who underwent KT. Clinical outcomes and survival after transplantation according to frailty status at listing was assessed. RESULTS: About 71.3% of total listed cohort resulted to be pre-frail (one criterion 41%, two criteria 19.8%) or frail (10.5%). Disparities were observed between sexes, with 5.2% of men and 21.9% of women being frail (P < 0.01). During the study period (median 26 months [IQR 16–39]), 296 patients got a KT and 153 remained listed. Patients who did not get transplanted were more frequently frail (16.3 versus 7.4%, P = 0.013). Frail patients had more hospital admissions during the first year after listing (43.4% if PFP ≥1 versus 20.8% if PFP = 0) and more cardiovascular events or major infectious events. In a multivariate model including only patients scoring 0 (robust) or prefail-1-criterion ( n = 217), older age, previous cerebrovascular disease, peripheral vascular disease and mild pre-frailty were independent risk factors for mortality after KT (Figure 1 ). CONCLUSION: Frailty is frequent in KT candidates, more frequent in women than men. Frail patients have less chances to receive a KT. KT candidates are frequently listed with one (out of five) frailty criterion, and this has an independent impact on patient survival after KT. A pre-transplant clinical framework for multimodal prehabilitation interventions to mitigate the effects of frailty and poor fitness after KT may be justified even in mildly pre-frail candidates.