*Purpose: Studies suggest worse outcomes for frail solid organ transplant recipients. We analyzed post transplant outcomes in relation to frailty.

*Methods: We conducted a retrospective study of 476 kidney transplant recipients from 1/1/2016-8/10/2020. Frailty was assessed using handgrip, physical inactivity, gait speed, weight loss and exhaustion. Scores as outlined in the fried frailty phenotype (FFP) assessment, 0 = not frail, 1-2 = pre-frail, 3-5 = frail. This cohort included pre-FFP tested recipients (no frailty testing) n = 325 and post-FFP tested (implementation of FFP testing) recipients n = 151. Changes in delayed graft function (DGF), length of stay (LOS), and 30-day readmission as primary outcomes pre- and post-implementation of FFP testing were analyzed. Logistic regression models were fitted to estimate the odds ratios of primary outcomes. Multivariable logistic regression was adjusted for age, gender, race, dialysis duration, diabetes, BMI, donor type (living vs deceased), cPRA, and previous transplant. P values < 0.05 were considered statistically significant.

*Results: The DGF rate significantly decreased from 44.3% to 29.8% post-FFP (OR 0.50, CI 95%: 0.32-0.78, P=0.003) compared to pre-FFP era. There was no significant change for LOS (52.9% vs 51.0%, p=0.70) (OR 1.10, 95%CI 0.72-1.67), but an increase in the 30-day readmission rate (32.4% vs 45.0%, p=0.01) (OR 170, 95%CI 1.13-2.56) post-FFP assessment.

*Conclusions: A significant association between frailty assessment and reduction in DGF rate was demonstrated. Use of frailty assessments in pre-transplant patient selection may be beneficial in reducing post-operative short-term outcomes.

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