Frailty and Long-Term Post-Kidney Transplant Outcomes

Abstract

Purpose of review: To highlight recent research about frailty and its role as a predictor of adverse, long-term post-kidney transplant (KT) outcomes. Recent findings: Frailty is easily measured using the physical frailty phenotype (PFP) developed by gerontologist Dr. Linda Fried and colleagues. In recent studies, >50% of KT recipients were frail (20%) or intermediately frail (32%) at KT admission. Frail recipients were at 1.3-times higher risk of immunosuppression intolerance and 2.2-times higher risk of mortality, even after accounting for recipient, donor, and transplant factors; these findings were consistent with those on short-term post-KT outcomes. Pilot data suggests that prehabilitation may be an intervention that increases physiologic reserve in frail KT recipients. Summary: The PFP is a effective tool to measure frailty in ESRD that improves risk stratification for short-term and long-term post-KT outcomes. Interventions to improve physiologic reserve and prevent adverse KT outcomes, particularly among frail KT recipients, are needed.

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

“…Additionally, prior studies have demonstrated the dynamic nature of frailty among ESKD patients undergoing HD, on the waitlist, or recipients post-KT, such that improvements in frailty scores can be observed over time [39-41]. This suggests that frailty in many cases is not an irreversible state of low physiological reserve [41, 42], which provides an optimistic avenue for intervention.…”

Frailty in CKD and Transplantation

“…44 A growing body of evidence describing the importance of measuring frailty in KT candidates is emerging and has previously been reviewed. 45,46 At the time of KT, 20% of patients are defined as frail according to the PFP. 47 Frailty has been associated with adverse outcomes before and after KT (Figure 2).…”

“…[91][92][93][94] Another aging process implicated in the pathogenesis of frailty is cellular senescence. 46,95 Cellular senescence is a state of essentially irreversible growth arrest that occurs in response to perturbations such as DNA damage and oxidative stress.…”

Protocolized exercise improves frailty parameters and lower extremity impairment: A promising prehabilitation strategy for kidney transplant candidates

“…Specifically, the combination of comorbidities, sarcopenia, and uremia‐associated inflammation contributes to the development of frailty and decreased functional status in many patients 4‐6 . Frailty is commonly defined as a syndrome of multi‐system physiologic dysfunction which leads to decreased ability to recover from adverse medical events 7 . Decreased functional status refers to challenges performing activities of daily living.…”