*Purpose: Currently there are no tools to predict outcomes after kidney transplantation (KTx). This study assesses whether frailty influences post-KTx complications. Understanding frailty and its effect on outcomes has significant implications for patient education and clinical management, including the listing of patients for KTx as a treatment option.

*Methods: We performed a retrospective, observational cohort study of KTx patients in our centre from 2016-2019. The pre-transplant Rockwood Clinical Frailty Score (CFS) was assessed on risk factors covering major domains of functioning and were categorized as follows: 1-3 (non-frail; group 1) and 4-6 (frail; group 2). Outcomes measured were: 30d mortality, 30d and 1yr readmission rates, death-censored graft survival and patient survival.

*Results: 219 patients met our inclusion criteria, with mean age at KTxof 50.5 +/- 13.2 (n=166) and 55.7 +/- 13.3 (n=53) in groups 1 and 2 respectively, p=0.01. The median time on dialysis was 2.3yrs (IQR 1.08-4.28) vs 2.6yrs (IQR 1.38-5.07); p=0.14. Two patients died within 30 days in both groups. Overall rates of readmission at 30d and 1yr were 21.7% and 50.6% vs. 32.1% and 70% (p=0.12 and 0.01, respectively); those related to an infective cause at 30 days were 8.4% and 17% (group 1 vs group 2; p=0.07) and 20.5% and 41.5% at 1yr (group 1 vs group 2; p=0.002). Frail recipients, irrespective of their age, were much more likely to experience readmission due to post-transplant infections (30d: 4.5% vs. 27.3% & 12m: 18.2% vs. 45.5%, p=0.05 and p=0.09, respectively for recipients >65 years); see Figure 1. Unadjusted death-censored graft survival was similar for both groups but patient survival at 3yrs was 96.2% and 85.1% respectively (p=0.02, log-rank test).

*Conclusions: Regardless of age, frailty is a risk factor for post-KTx morbidity. Identifying frail KTx recipients might allow for targeted outpatient monitoring and intervention to reduce hospital readmission rates.

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