*Purpose: Frailty and disabilities are highly prevalent among kidney transplant (KT) recipients, but are not routinely measured in KT recipients. The Karnofsky Performance Scale (KPS) is a clinically perceived measure used to evaluate patient’s ability to manage daily activities, but little is known about its post-KT trajectories and its relationship to frailty and disability in KT recipients.

*Methods: We leveraged a cohort of 159,992 adult KT recipients using SRTR data (1/2005-6/2018) whose post-KT functional status was recorded using KPS (range 10%-100% integers). Additionally, we studied 1,106 adult KT recipients from a prospective cohort study on aging and KT for whom KPS was also recorded in SRTR, in addition to geriatric measures of vulnerability and functional status (frailty, activities of daily living (ADL), instrumental activities of daily living (IADL), and lower extremity impairment (SPPB≤10)). In each separate cohort, we used linear mixed effects models to assess differences in trajectories of KPS post-KT.

*Results: In 159,992 KT recipients in SRTR, the mean unadjusted KPS score was 88.34% (95%CI: 88.28%, 88.40%) and declined at a rate of -0.59%/year (95%CI: -0.61%, -0.57%) post-KT, such that by 2-years post-KT the average was 87.00% (95%CI: 86.94%, 87.05%). Age at KT was associated with steeper decline in KPS (Table 1). Rates of change in KPS differed by age, such that older recipients experienced steeper declines compared to younger recipients (Table 2). Rate of decline did not differ by sex or race. In 1,105 KT recipients in the prospective cohort study, KPS functional status is distinct from frailty, ADL, IADL, and SPPB (Figure 1). Improvements in those without ADL/IADL disability were observed in adjusted models but change in KPS did not differ between those with and without these disabilities, frailty, or lower extremity impairment.

*Conclusions: KPS is a measure of functional status distinct from frailty, ADL, IADL, and SPPB at KT admission that declines with older age post-KT. Older KT recipients should be monitored closely for declines in physical function, and potentially undergo prehabilitation to improve functional status post-KT.

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