*Purpose: Patients with frailty who undergo renal transplantation (RT) have a higher incidence of delayed graft function and rehospitalization, however little is known about the ability of frail patients to sustain the wait to RT. This study used the Timed-Up-and-Go Test (TUGT) and Montreal Cognitive Assessment (MoCA) as surrogates for frailty to determine outcomes for renal transplant candidates.

*Methods: A single-institution retrospective review was performed for all patients being evaluated for RT who underwent TUGT and MoCA between 2015 and 2019. These tests were not used to determine candidacy. RT candidates were considered to have a favorable outcome if they were transplanted or remained on the list. However, patients that were not listed, removed from the list, or deceased were considered to have unfavorable outcomes. The outcomes were compared against patient characteristics: demographics, education level, language, comorbidities, dialysis type, use of a walking device, and results of the TUGT and MoCA. Mann-Whitney and Kruskal-Wallis tests were used to compare continuous variables and the Pearson chi-squared test was used to compare categorical variables. Logistic regression was performed for univariate and multivariate analysis. All statistical tests were performed using SPSS Statistics Subscription. A confidence interval (CI) of 95% and p-value of < 0.05 for statistical significance were used.

*Results: Both TUGT and MoCA were performed in 526 RT candidates who had a mean age of 56 years and were 61% male, 73% Asian, 90.7% high school graduates, and 45.8% had 3 or more comorbidities. In this cohort, 230 patients (43.7%) passed TUG, 268 (51%) passed MoCA (>24 points), 133 (25.3%) passed both TUG and MoCA, and 161 (30.6%) failed both TUG and MoCA. Factors with statistically significant differences between favorable and unfavorable outcome were age, education level, three or more comorbidities, cardiac disease, passing TUGT, and passing MoCA. Multivariate analysis demonstrated that factors that were associated with unfavorable status outcomes were age ≥65 (OR 1.64, CI 1.08- 2.5, p = 0.02), cardiac disease history (OR 3.34l, CI 2.20 – 5.10, p <0.001), and failing TUGT (OR 2.19, CI 1.48 - 3.26, p <0.001). Failing MoCA was not associated with an unfavorable outcome during transplant candidacy (OR 1.398, CI 0.95 - 2.05, p = 0.09).

*Conclusions: This is the first study that evaluated both TUGT and MoCA as markers of frailty and the outcomes of RT candidates. MoCA was not associated with RT outcomes, however passing the TUGT was associated with favorable outcomes of either receiving RT or remaining on the list. Further studies are required to determine the outcomes of these surrogates of frailty on RT outcomes.

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