Change in Frailty Between Evaluation for Kidney Transplantation and Transplantation

M. McAdams DeMarco, E. King, N. Desai, N. Dagher, B. Lonze, R. Montgomery, D. Segev.

Johns Hopkins, Baltimore, MD.

Meeting: 2015 American Transplant Congress

Abstract number: B229

Keywords: Age factors, Kidney transplantation

BACKGROUND: Frailty prevalence is high and predicts early hospital readmission, length of stay and mortality in adults of all ages undergoing kidney transplantation (KT). The goal of this work was to understand what happens to frailty scores between evaluation for KT and KT.

METHODS: 167 patients being evaluated for KT were enrolled in a prospective cohort study (November 2009 and November 2013) and went on to receive a KT (through April 2014). The Fried frailty score was measured at the time of evaluation and transplantation. We evaluated the change in frailty status (nonfrail=score of 0 or 1; intermediately frail=score of 2; and frail=score ≥3). We identified factors (age, sex, race, donor type, time between evaluation and KT, and frailty status at evaluation) that were associated with worsening frailty (change in frailty score>0) using logistic regression.

RESULTS: At the time of evaluation, 21% were frail and at KT 20% were frail. The median time between evaluation and KT was 9 months (IQR: 5-15 months; range: 2 weeks-3.4 years); 98 (59%) recipients were transplanted within 1 year. Frailty status was static between evaluation and KT for 52% of KT recipients; 31% remained nonfrail, 10% remained intermediately frail and 11% remained frail.

Frailty status at the time of KT evaluation and KT.

	At Transplantation
At Evaluation	Nonfrail	Intermediately frail	Frail
Nonfrail	52 (31)	30 (18)	8 (5)
Intermediately frail	17 (10)	16 (10)	9 (5)
Frail	6 (3)	12 (7)	17 (11)

Number (%) are reported By the time of KT 28% became more frail and 20% became less frail. The only factor that was associated with worsening frailty scores between evaluation and KT was frailty status at the time of evaluation (intermediately frail at evaluation: OR=4.28, 95% CI: 1.66-11.04, P=0.003 and frail at evaluation: OR=11.01, 95%CI: 4.10-29.52, P<0.001).

CONCLUSIONS: Between evaluation and KT, only half of all KT recipients have stable frailty status and those who are intermediately frail and frail are more likely to have worsening scores by the time of KT. These findings suggest that frailty should be measured not only at the time of evaluation but also at the time of KT to help inform clinical decision making and post-operative care.

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