Background: Frailty and decreased physical performance are associated with poor outcomes after kidney transplant. Less is known about their relationship with pre-transplant outcomes. The aim of this study was to characterize associations between frailty and physical performance with death on the kidney transplant waiting list.

Methods: Since 12/2014, kidney transplant candidates at our center deemed “high-risk” (age > 59, diabetic and/or history of > 3 years dialysis) have undergone frailty and physical performance testing during their pre-transplant evaluations. Patients who were evaluated and approved for transplant since then were retrospectively analyzed and censored at the time of transplant. Frailty was measured using Fried Criteria, and physical performance testing was obtained using the Short Physical Performance Battery (SPPB) which provides a composite measure of balance, gait speed and chair stand time. SPPB scores range from 0 (unable to perform) to 12 (no difficulty performing).

Results: Between 12/2014 and 11/2016, 486 high-risk candidates were evaluated and approved for kidney transplant at our center. Mean age was 60 ± 11, 61% were male, 52% were diabetic 80% were Caucasian and 60% required dialysis. Of these patients, 292 (60%) underwent frailty and physical performance testing. 13% of patients were frail. Mean SPPB score in frail patients was 8.9 ± 3.3, whereas mean SPPB score in non-frail patients was 11.4 ± 1.3 (p<0.0001). After waitlisting, 10 patients died. Mean time from evaluation to death was 9 ± 6 months. Frail patients were more likely to die on the waiting list compared to nonfrail patients (8% vs 1%, p=0.01). Patients with a SPPB score < 10 were also more likely to die on the waiting list compared to patients with a higher SPPB score (9% vs 1%, p=0.01). The relationship between frailty, SPPB score < 10 and death on the waiting list was independent of age, diabetes, duration of dialysis or cardiac troponin T.

Discussion: Frail kidney transplant candidates have worse physical performance. Both frailty and decreased physical performance are associated with death on the waiting list. Further studies are needed to determine whether improving frailty and physical performance prior to transplant can improve survival on the waiting list.

CITATION INFORMATION: Lorenz E, Cosio F, Bernard S, Bogard S, Bjerke B, Geissler E, Hanna S, Kremers W, Stegall M, Cheville A, LeBrasseur N. The Relationship Between Frailty and Decreased Physical Performance with Death on the Kidney Transplant Waiting List. Am J Transplant. 2017;17 (suppl 3).

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