Of the Individual Components of a Modified Freid Frailty Score, Pre-Transplant Walk Time and Grip Strength Are the Strongest Predictors of Post Kidney Transplant Outcomes

S. Parajuli, F. Aziz, H. L. Lorden, K. A. O'Toole, R. E. Wallschlaeger, I. C. Breyer, B. Dodin, J. Goronzik Wang, D. A. Mandelbrot

University of Wisconsin, Madison, WI

Meeting: 2022 American Transplant Congress

Abstract number: 220

Keywords: Outcome, Post-operative complications, Rejection, Risk factors

Topic: Clinical Science » Kidney » 35 - Kidney: Cardiovascular and Metabolic Complications

Session Information

Session Name: Kidney: Cardiovascular and Metabolic Complications II

Session Type: Rapid Fire Oral Abstract

Date: Monday, June 6, 2022

Session Time: 3:30pm-5:00pm

Presentation Time: 4:10pm-4:20pm

Location: Hynes Veterans Auditorium

*Purpose: Frailty assessment has become common during evaluation for kidney transplantation; however, a variety of different tools are used for frailty assessment. The Freid frailty score is the most commonly used assessment and includes weight loss, self-reported exhaustion, physical activity, walk time, and handgrip. It is not known which of these five variables has the most predictive value for specific outcomes in kidney transplant recipients (KTRs).

*Methods: Since 06/2016 we have assessed pre-transplant frailty utilizing a modified Fried frailty score which replaces physical activity with the Karnofsky score. We analyzed post-transplant outcomes based on the sum frailty score as well as each of the five individual components. Outcomes of interest were delayed graft function (DGF), readmission within 30 days after discharge from transplant, any cardiovascular (CV) events needing hospitalization post-transplant, acute rejection (AR), death censored graft failure (DCGF), and death.

*Results: A total of 825 KTRs transplanted between 06/2016-12/2020 had a pre-transplant frailty assessment. 58% had a sum frailty score f 0, 30% had a 1, 10% had a 2, 1% had a 3, 0.4% had a 4, and none had a sum frailty score of 5. After adjustment for multiple confounding factors, sum frailty was associated with 30 day readmission (HR: 1.31; 95% CI: 1.08-1.58; p=0.005) and CV events (HR: 1.41; 95% CI: 1.12-1.78; p=0.003). When looking at individual variables, walk time was significantly associated with increased risk of DGF ( HR: 1.99; 95% CI: 1.15-3.42; p=0.01) and grip strength with 30 day readmission (HR: 1.53; 95% CI: 1.08-2.17; p=0.02), and CV events (HR: 1.74; 95% CI: 1.13-2.65; p=0.01). None of the other variables were associated with outcomes of interest.

*Conclusions: In this large series of KTRs, we found walk time and grip strength to be associated with poor outcomes. Exhaustion and weight loss are relatively non-specific, and widespread among patients before transplant, which may explain their lack of predictive value in our study. Pre-transplant rehabilitation to improve frailty may improve post-transplant outcomes.

To cite this abstract in AMA style:

Parajuli S, Aziz F, Lorden HL, O'Toole KA, Wallschlaeger RE, Breyer IC, Dodin B, Wang JGoronzik, Mandelbrot DA. Of the Individual Components of a Modified Freid Frailty Score, Pre-Transplant Walk Time and Grip Strength Are the Strongest Predictors of Post Kidney Transplant Outcomes [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/of-the-individual-components-of-a-modified-freid-frailty-score-pre-transplant-walk-time-and-grip-strength-are-the-strongest-predictors-of-post-kidney-transplant-outcomes/. Accessed November 21, 2024.

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