Associations of Poor Physical and Cognitive Performance and Kidney Transplant Waiting List Denial
1Drexel University College of Medicine, Philadelphia
2Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
Meeting: 2018 American Transplant Congress
Abstract number: A310
Keywords: Outcome, Waiting lists
Session Information
Session Name: Poster Session A: Non-Organ Specific: Disparities to Outcome and Access to Healthcare
Session Type: Poster Session
Date: Saturday, June 2, 2018
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall 4EF
Background: Little is known about the clinical impacts of physical and cognitive impairments on kidney transplantation (KT) candidacy.
Methods: We enrolled 170 adults (age> 18 years) who were newly evaluated for KT at a single center between January 1, 2016 and December 31, 2016 in a prospective cohort study. Participants were tested for grip strength (kilograms [kg]), gait speed (meters/second [m/s]), and cognitive function with the Montreal Cognitive Assessment (MOCA). Participants' physician evaluators were blinded to their functional performance and rated their likelihood of waiting list denial. We fit multivariable logistic regression models to examine the association of physical and cognitive performance with waiting list denial in 12 months, compared to physician prediction of denial.
Results: The median age was 58 years (interquartile range [IQR] 49-66), 66% were black, 62% were male, and 53% were diabetic. The cohort's median MOCA score was 22 (IQR 19-24), gait speed was 0.7 m/s (IQR 0.6-0.9), and grip strength was 22 kg for females (IQR 18-26) and 32 kg (IQR 26-40) for males. After 12 months, 45 participants (27%) were denied listing. Compared to higher quartiles, the lowest quartiles of MOCA, grip strength, and gait speed were each independently associated with higher odds of waiting list denial in logistic regression models also adjusted for age, race, sex, education, insurance, comorbidities, and social support. Compared with a model of physician prediction of waiting list denial, a model that also included cognitive and physical performance had similar discriminative accuracy (C-statistic 0.70 vs 0.71, p=0.7). 
Conclusion: Poor physical and cognitive performance were associated with denial from the KT waiting list, but did not augment physician prediction of waiting list denial. Future multi-center studies are needed to examine the potential roles of functional metrics in KT waiting list management.
CITATION INFORMATION: Harhay M., Ranganna K., Michie F., Selinski C., Bajakian T., Levin Mizrahi L., Lee J., Malat G., Xiao G., Reich D., Guy S., Reese P. Associations of Poor Physical and Cognitive Performance and Kidney Transplant Waiting List Denial Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Harhay M, Ranganna K, Michie F, Selinski C, Bajakian T, Mizrahi LLevin, Lee J, Malat G, Xiao G, Reich D, Guy S, Reese P. Associations of Poor Physical and Cognitive Performance and Kidney Transplant Waiting List Denial [abstract]. https://atcmeetingabstracts.com/abstract/associations-of-poor-physical-and-cognitive-performance-and-kidney-transplant-waiting-list-denial/. Accessed November 23, 2024.« Back to 2018 American Transplant Congress