Frailty and prognosis of patients with kidney transplantation: a meta-analysis

Abstract

Background The prevalence of frailty among candidates and recipients of kidney transplantation (KT) is well-established, yet the impact of frailty on clinical outcomes following KT remains uncertain. To address this knowledge gap, we conducted a systematic meta-analysis to comprehensively assess the aforementioned relationship. Methods The present study conducted a comprehensive search of PubMed, Embase, and Cochrane Library databases to identify relevant observational studies that compared mortality risk and other clinical outcomes of KT recipients with and without frailty. Two authors independently conducted data collection, literature searching, and statistical analysis. The results were synthesized using a heterogeneity-incorporating random-effects model. Results In this meta-analysis, 6279 patients from 13 cohort studies were included, and 1435 patients (22.9%) were with frailty before KT. There were higher mortality rates among frail patients at admission, compared to those without frailty (risk ratio [RR]: 1.97, 95% confidence interval [CI]: 1.57 to 2.47, p < 0.001; I2 = 19%). Subgroup analysis suggested the association between frailty and high mortality risk after KT was consistent in studies of frailty assessed via Physical Frailty Phenotype or other methods, and in studies of follow-up duration < or ≥ 5 years. In addition, frailty was associated with higher incidence of delayed graft function (RR: 1.78, 95% CI: 1.21 to 2.61, p = 0.003; I2 = 0%), postoperative complications (RR: 1.88, 95% CI: 1.15 to 3.08, p = 0.01; I2 = 0%), and longer hospitalization (RR: 1.55, 95% CI: 1.22 to 1.97, p < 0.001; I2 = 0%). Conclusion Following KT, frail patients are at higher risks for all-cause mortality, delayed graft function, postoperative complications, and longer hospital stays.

Abdominal Organ Transplantation: Noteworthy Literature in 2023

“…The authors noted that the heterogeneity of methods for evaluating and diagnosing frailty was a limitation to their analysis, and that further study is needed to develop a gold-standard definition of frailty. 3 Delirium has also been associated with poor outcomes following kidney transplantation. 25 In a retrospective study of 35,800 kidney transplant recipients ≥55 years old, Ruck et al observed that risk factors for delirium in these patients included advanced age and diabetes mellitus.…”

“…The authors noted that the heterogeneity of methods for evaluating and diagnosing frailty was a limitation to their analysis, and that further study is needed to develop a gold-standard definition of frailty. 3…”