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Impact of Frailty on Early and Late Hospital Readmission after Kidney Transplantation

H. Hendra1, B. Sandhu2, E. Frackiewicz2, G. Jones2, P. Masson2, R. Motallebzadeh3

1Centre for Transplantation, Department of Renal Medicine, University College London & Royal Free London NHS Foundation Trust, London, United Kingdom, 2Royal Free Hospital, London, United Kingdom, 3Centre for Transplantation, University College London & Royal Free London NHS Foundation Trust, London, United Kingdom

Meeting: 2020 American Transplant Congress

Abstract number: 277

Keywords: Infection

Session Information

Session Name: Kidney Infections Excluding Polyoma & Viral Hepatitis

Session Type: Oral Abstract Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:45pm

 Presentation Time: 4:27pm-4:39pm

Location: Virtual

*Purpose: Currently there are no tools to predict outcomes after kidney transplantation (KTx). This study assesses whether frailty influences post-KTx complications. Understanding frailty and its effect on outcomes has significant implications for patient education and clinical management, including the listing of patients for KTx as a treatment option.

*Methods: We performed a retrospective, observational cohort study of KTx patients in our centre from 2016-2019. The pre-transplant Rockwood Clinical Frailty Score (CFS) was assessed on risk factors covering major domains of functioning and were categorized as follows: 1-3 (non-frail; group 1) and 4-6 (frail; group 2). Outcomes measured were: 30d mortality, 30d and 1yr readmission rates, death-censored graft survival and patient survival.

*Results: 219 patients met our inclusion criteria, with mean age at KTxof 50.5 +/- 13.2 (n=166) and 55.7 +/- 13.3 (n=53) in groups 1 and 2 respectively, p=0.01. The median time on dialysis was 2.3yrs (IQR 1.08-4.28) vs 2.6yrs (IQR 1.38-5.07); p=0.14. Two patients died within 30 days in both groups. Overall rates of readmission at 30d and 1yr were 21.7% and 50.6% vs. 32.1% and 70% (p=0.12 and 0.01, respectively); those related to an infective cause at 30 days were 8.4% and 17% (group 1 vs group 2; p=0.07) and 20.5% and 41.5% at 1yr (group 1 vs group 2; p=0.002). Frail recipients, irrespective of their age, were much more likely to experience readmission due to post-transplant infections (30d: 4.5% vs. 27.3% & 12m: 18.2% vs. 45.5%, p=0.05 and p=0.09, respectively for recipients >65 years); see Figure 1. Unadjusted death-censored graft survival was similar for both groups but patient survival at 3yrs was 96.2% and 85.1% respectively (p=0.02, log-rank test).

*Conclusions: Regardless of age, frailty is a risk factor for post-KTx morbidity. Identifying frail KTx recipients might allow for targeted outpatient monitoring and intervention to reduce hospital readmission rates.

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To cite this abstract in AMA style:

Hendra H, Sandhu B, Frackiewicz E, Jones G, Masson P, Motallebzadeh R. Impact of Frailty on Early and Late Hospital Readmission after Kidney Transplantation [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/impact-of-frailty-on-early-and-late-hospital-readmission-after-kidney-transplantation/. Accessed May 10, 2025.

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