Frailty at Time of Kidney Transplant Evaluation is Associated with Higher Rate of Waitlist Denial
1Nephrology, University of Kansas Medical Center, Kansas City, KS, 2University of Kansas Medical Center, Kansas City, KS
Meeting: 2020 American Transplant Congress
Abstract number: D-073
Keywords: Kidney transplantation, Prognosis, Screening, Waiting lists
Session Information
Session Name: Poster Session D: Kidney Psychosocial
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: To determine the association of patient frailty, as assessed by the Fried frailty score at the time of kidney transplant evaluation (KTE), with kidney transplant eligibility and time from initial evaluation to completion of KTE tasks.
Frailty, a conventional geriatric measure for physiologic reserve, is an independent risk factor for multiple adverse post-kidney transplant outcomes. However, frailty is not routinely measured at the time of KTE. Further, it is unknown whether frailty influences transplant eligibility in the first place.
*Methods: We assessed frailty via the Fried frailty score at the time of KTE in all patients who were referred to our transplant center. Patients with diagnosis of CKD IV or V with an estimated gfr below 20 ml/minute or on maintenance dialysis and able to sign the informed consent were included. Patients who were evaluated for combined organ transplant or unable to complete the study were excluded. We utilized Fried frailty testing and scoring previously validated in KT (1). The frailty score is the sum of the component scores (0-5). Non-frail is defined as 0 or 1, and frail is defined as a score of 2 or higher. The transplant selection committee determining eligibility was blinded to the patient’s frailty score. Waitlist eligibility or denial was assessed at 6 months after KTE. All patients who were not denied were categorized as eligible.
*Results: We enrolled 125 patients. 62.4% were male, 62% Caucasian and 24% African American. There were 54 (43.2%) frail patients and they were 50% male, 39% Caucasian and 43% African American. There were 41/125 (32%) patients denied KT, and 56% were frail. Frail patients as compared to non-frail patients had a higher risk of waitlist decline (RR 1.68, 95% CI 1.014-1.64, p=0.041). At 6 months after initial KTE, frail patients were less likely to be actively listed for KT (RR 1.29, 95% CI 1.014-2.64, p=0.038).
| Patients at KTE (n=125) | Frail (n=54) | Non-Frail (n=71) |
| Denied (n=41) | 23 | 18 |
| Relative Risk | 1.68 (95% CI 1.01-1.64) p=0.041 |
*Conclusions: Patients identified as frail at the time of KT evaluation have a greater risk of waitlist denial. Frail patients eligible for KT are less likely to be actively listed at 6 months after initial KT evaluation.
References
1 McAdams M, Ying H, Olorundare I, King E, Haugen C. Individual Frailty Components and Mortality in Kidney Transplant Recipients. Transplantation. 2017; 101 (9): 21262132
To cite this abstract in AMA style:
Klein J, Jurgensen A, Gupta M, Herrera N, Gupta A, Cibrik D. Frailty at Time of Kidney Transplant Evaluation is Associated with Higher Rate of Waitlist Denial [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/frailty-at-time-of-kidney-transplant-evaluation-is-associated-with-higher-rate-of-waitlist-denial/. Accessed November 25, 2024.« Back to 2020 American Transplant Congress