*Purpose: Frailty, a measure of physiologic reserve, is associated with poor early outcomes, like early hospital readmission (EHR) and delayed-graft function (DGF) in kidney transplant recipients (KTR). Both DGF and EHR confer to poorer quality of life in KTR and high financial burden to the healthcare system. Standard frailty metrics, like the cumulative deficit index and Fried’s phenotype, are often not clinically available, thus making assessment of frailty difficult. The objectives of this study are: 1) to assess frailty with a surrogate index constructed using measures that are part of routine tests done at our centre and 2) to investigate the implications of frailty on EHR and DGF among KTR.

*Methods: We conducted a single-centre retrospective cohort study looking at KTR transplanted between July 1, 2008-December 31, 2017 with a minimum of one-year follow-up period. Prior non-kidney transplants and transplants done outside of our centre were excluded. EHR was defined as the first hospitalization within 30 days after transplant discharge while DGF was defined as the requirement of dialysis within 7 days of transplant. The surrogate frailty index consisted of thirteen elements assessing patients’ cumulative level of physical and psychosocial deficits. The elements were adopted from our centre-specific nursing admission assessment routinely administered prior transplant. Risk factors and clinical outcomes were examined using Cox proportional hazard models.

*Results: Our final cohort size was 1,530 KTR. The median frailty index was 1.5 (IQR: 0.5, 2.0). An increase in frailty index score was significantly associated with EHR (HR: 1.17, 95% C.I.: 1.05, 1.29). Similarly, an increase in frailty index score was also significantly associated with DGF (OR= 1.24, 95% C.I.: 1.07, 1.43). Furthermore, a change in frailty index was significantly associated with the duration of DGF (OR= 1.89, 95% C.I.: 1.03, 3.46).

*Conclusions: The surrogate frailty index was created using assessments that are easily accessible. Based on these measures, frailty was found to be significantly associated with EHR and DGF among KTR. Further exploration of the role of frailty in KTR is necessary to better understand how frailty impacts early post-transplant outcomes. The standardization of frailty assessments may be warranted to help improve care provided for KTRs.

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