Frailty and solid-organ transplant candidates: a scoping review

Abstract

Background There is currently no consensus as to a standardized tool for frailty measurement in any patient population. In the solid-organ transplantation population, routinely identifying and quantifying frailty in potential transplant candidates would support patients and the multidisciplinary team to make well-informed, individualized, management decisions. The aim of this scoping review was to synthesise the literature regarding frailty measurement in solid-organ transplant (SOT) candidates. Methods A search of four databases (Cochrane, Pubmed, EMBASE and CINAHL) yielded 3124 studies. 101 studies (including heart, kidney, liver, and lung transplant candidate populations) met the inclusion criteria. Results We found that studies used a wide range of frailty tools (N = 22), including four ‘established’ frailty tools. The most commonly used tools were the Fried Frailty Phenotype and the Liver Frailty Index. Frailty prevalence estimates for this middle-aged, predominantly male, population varied between 2.7% and 100%. In the SOT candidate population, frailty was found to be associated with a range of adverse outcomes, with most evidence for increased mortality (including post-transplant and wait-list mortality), post-operative complications and prolonged hospitalisation. There is currently insufficient data to compare the predictive validity of frailty tools in the SOT population. Conclusion Overall, there is great variability in the approach to frailty measurement in this population. Preferably, a validated frailty measurement tool would be incorporated into SOT eligibility assessments internationally with a view to facilitating comparisons between patient sub-groups and national and international transplant services with the ultimate goal of improved patient care.

Use of frailty assessment instruments in nephrology populations: a scoping review

“…The range of instruments utilised by studies included in this review re ects the lack of consensus regarding the best instruments for assessing frailty(98, 99). This heterogeneity has similarly been reported by scoping reviews examining frailty assessment in acute care settings (25) and solid organ transplantation (100). Assessment settings and contexts were poorly described across studies, although the majority of studies that did provide this detail indicated a propensity for CKD patient assessment in the outpatient setting, while transplant candidates were most commonly assessed at admission for kidney transplantation surgery.…”

Assessing nutrition status, sarcopenia, and frailty in adult transplant recipients

“…They both contribute to a decline in quality of life because of their contribution to reduced mobility and compromised performance of daily tasks, ultimately leading to a loss of independence. [15][16][17] Frailty significantly increases the risk of mortality while on the waiting list for kidney, lung, liver, and heart transplant. [18][19][20][21] Furthermore, it reduces the likelihood of being listed for kidney transplant by 50% and lowers the probability of receiving a kidney transplant by 32%.…”

“…30 Finally, frailty has been shown to be associated with higher posttransplant mortality in kidney, 31 lung, 32 heart 33 and liver transplantation. 17 Similarly, sarcopenia has been associated with a 2.0-2.4fold increased risk of mortality while on the waitlist for liver transplant. 34,35 Sarcopenia has also been associated with increased mortality after both living-donor 36,37 and deceaseddonor liver transplant 1 and 3 years 38 posttransplant, as well as after kidney transplant.…”

“…Sarcopenia and frailty have a strong association with adverse outcomes in transplantation. They both contribute to a decline in quality of life because of their contribution to reduced mobility and compromised performance of daily tasks, ultimately leading to a loss of independence 15–17 …”

Putting Guidelines Into Practice: Is Frailty Measurement at the Time of Kidney Transplant Eligibility Assessment Valid, Feasible, and Acceptable to Patients?

“…The FFP is reproducible, clinically coherent with frailty being a wasting disorder with sarcopenia as a key pathophysiological feature, and predicts a wide range of adverse outcomes in the general and solid organ transplantation populations. 14,16 However, it has practical limitations (eg, grip strength and gait speed are not routinely measured in KT candidates, and weight loss poses challenges in the setting of dialysis), 17,18 and the omission of other health domains is not consistent with the solid organ transplantation community's conceptualization of frailty as a multidimensional construct. 18 The Frailty Index (FI) represents the risk state (cumulative deficits) model of frailty.…”