Frailty predicts surgical complications after kidney transplantation. A propensity score matched study

Mantovani, Milena dos Santos; Carvalho, Nyara Coelho de; Archangelo, Thomáz; Andrade, Luís Gustavo Modelli de; Filho, Sebastião Pires Ferreira; Cavalcante, Ricardo de Souza; Kawano, Paulo Roberto; Papini, Sílvia Justina; Costa, Nara Aline; Almeida, Ricardo Augusto Monteiro de Barros

doi:10.1371/journal.pone.0229531

Cited by 28 publications

(27 citation statements)

References 39 publications

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“…Four studies reported data on the association between frailty and DGF for both frail and nonfrail patients. 25 , 27 , 28 , 32 All 4 studies defined DGF as the need for dialysis during the first 7 postoperative days. 19 Overall, frail patients had an increased risk of DGF compared with nonfrail patients (OR, 1.80; 95% CI, 1.1-3.0).…”

Section: Resultsmentioning

confidence: 99%

Frailty and Kidney Transplantation: A Systematic Review and Meta-analysis

Quint

Zogaj

Benjamens

et al. 2021

Transplantation Direct

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Background. Frailty is a multidimensional condition and is the result of the body’s age-associated decline in physical, cognitive, physiological, and immune reserves. The aim of this systematic review is to assess the quality of evidence of the included studies, determine the prevalence of frailty among kidney transplant candidates, and evaluate the relationship between frailty and associated patient characteristics and outcomes after kidney transplantation. Methods. A systematic search was performed for relevant literature on frailty and kidney transplantation. This was followed by a meta-analysis for patient characteristics and outcomes reported by a minimum of 2 studies including mean age, gender, mean body mass index, type of kidney transplantation, dialysis, previous kidney transplantation, comorbidities, hypertension, race, preemptive kidney transplantation, delayed graft function, and length of stay. Results. A total of 18 studies were included in the systematic review and 14 of those studies were suitable for meta-analysis. The overall pooled prevalence of frailty before transplantation was estimated at 17.1% (95% confidence interval [CI], 15.4-18.7). Frailty was significantly associated with higher age (mean difference, 3.6; 95% CI, 1.4-5.9), lower rate of preemptive transplantation (relative risk, 0.60; 95% CI, 0.4-0.9), longer duration of delayed graft function (relative risk, 1.80; 95% CI, 1.1-3.0), and length of stay longer than 2 wk (odds ratio, 1.64; 95% CI, 1.2-2.3). Conclusions. One in 6 kidney transplant recipients is frail before transplantation. The presence of frailty is associated with lower rates of preemptive transplantation, older recipient age, higher rates of delayed graft function, and longer length of stay. Future research is required to explore the association of frailty with other adverse outcomes after kidney transplantation and the effects of intervention programs to improve the different frailty domains.

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Section: Resultsmentioning

confidence: 99%

Frailty and Kidney Transplantation: A Systematic Review and Meta-analysis

Quint

Zogaj

Benjamens

et al. 2021

Transplantation Direct

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“…High BMI level at the time of transplantation is associated with increased risk of posttransplant mortality, graft failure, delayed graft function, and other surgical complications 5‐7 . Low BMI levels have also been shown as a risk factor for diminished posttransplant outcomes, which in some cases may relate to frailty and sarcopenia 8‐11 . Cumulatively, there is a well‐established “J‐Shaped” curve characterizing risks associated with BMI for kidney transplant recipients.…”

Section: Introductionmentioning

confidence: 99%

Effects of body mass index on kidney transplant outcomes are significantly modified by patient characteristics

Schold

Augustine

Huml

et al. 2021

American Journal of Transplantation

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Body mass index (BMI) is a known risk factor associated with kidney transplant outcomes and is incorporated for determining transplant candidate eligibility. However, BMI is a coarse health measure and risks associated with BMI may vary by patient characteristics. We evaluated 296 807 adult (age > 17) solitary kidney transplant recipients from the Scientific Registry of Transplant Recipients (2000‐2019). We examined effects of BMI using survival models and tested interactions with recipient characteristics. Overall, BMI demonstrated a “J‐Shaped” risk profile with elevated risks for overall graft loss with low BMI and obesity. However, multivariable models indicated interactions between BMI with recipient age, diagnosis, gender, and race/ethnicity. Low BMI was relatively higher risk for older recipients (>60 years), people with type I diabetes, and males and demonstrated no additional risk among younger (18‐39) and Hispanic recipients. High BMI was associated with elevated risk for Caucasians and attenuated risk among African Americans and people with type II diabetes. Effects of BMI had variable risks for mortality vs graft loss by recipient characteristics in competing risks models. The association of BMI with posttransplant outcomes is highly variable among kidney transplant recipients. Results are important considerations for personalized care and risk stratification. Findings suggest that transplant contraindications should not be based on absolute BMI thresholds but modified based on patient characteristics.

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“…In the first 24 hours after kidney transplantation, nursing actions aim to prevent complications and prioritize the continuous evaluation of general health status with noninvasive monitoring of vital signs and evaluation of the nursing team of 1 hour/1 hour in the first 12 postoperative hours, which allows early and appropriate interventions for each type of worsening. This period of great potential for hemodynamic instability, cardiovascular and neurological complications, important metabolic alterations and the need for replacement of parenteral fluids in large volumes that require intensive care for the maintenance of life (5,23,43,(44)(45)(46)(47)(48)(49).…”

Section: Resultsmentioning

confidence: 99%

Nursing Care for Kidney Transplant Patients: A Scoping Review

et al. 2021

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Objectives: Mapping nursing care in kidney transplant patients. Materials and method: A scoping review was conducted according to the recommendations of the Joanna Briggs Institute Reviewers’ Manual. Data were collected through 13 national and international databases from December 2020 to January 2021, following scientific rigor in the selection of the material. The pre-selection was made by reading the title, abstract and introductory text in advance; the materials included in this stage were read in full to define the content for the study. Results: Fifteen studies were included. Of these, 60% are articles; dissertations, manuals, protocols, guidelines and bulletins totaled 40% of the material studied. 86.6% of the material has a quantitative approach. Regarding the methodological design, 73.3% were descriptive/transversal character studies. Regarding the mapping of nursing care, it was possible to divide them into two categories: nursing care after kidney transplantation (immediate, mediated and late) and nursing care after kidney transplantation in primary health/extra-hospital care. Conclusions: It is concluded that the study allowed mapping nursing care to kidney transplant patients in the immediate, late and primary health care periods.

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Frailty predicts surgical complications after kidney transplantation. A propensity score matched study

Cited by 28 publications

References 39 publications

Frailty and Kidney Transplantation: A Systematic Review and Meta-analysis

Frailty and Kidney Transplantation: A Systematic Review and Meta-analysis

Effects of body mass index on kidney transplant outcomes are significantly modified by patient characteristics

Nursing Care for Kidney Transplant Patients: A Scoping Review

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