Transplant Centers That Assess Frailty as Part of Clinical Practice Have Better Outcomes

X. Chen¹, Y. Liu¹, V. Thompson¹, N. M. Chu¹, E. A. King¹, J. D. Walston², J. A. Kobashigawa³, D. M. Dadhania⁴, D. L. Segev¹, M. A. McAdams-DeMarco¹

¹Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, ²Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, ³Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, ⁴Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY

Meeting: 2022 American Transplant Congress

Abstract number: 602

Keywords: Age factors, Kidney transplantation, Prognosis, Waiting lists

Topic: Administrative » Administrative » 01 - Quality Assurance Process Improvement & Regulatory Issues

Session Information

Session Name: Quality Assurance Process Improvement & Regulatory Issues

Session Type: Poster Abstract

Date: Saturday, June 4, 2022

Session Time: 5:30pm-7:00pm

Presentation Time: 5:30pm-7:00pm

Location: Hynes Halls C & D

*Purpose: Frailty predicts adverse post-kidney transplant (KT) outcomes, yet impacts of frailty assessments on center-level outcomes remain unclear. We tested whether transplant centers assessing frailty as part of clinical practice have better pre- and post-KT outcomes in adult patients (18+) and older patients (65+).

*Methods: We conducted a survey of US transplant centers (11/2017-4/2018); 132 centers (response rate=65.3%) reported frequencies of frailty assessment at evaluation and KT. Center characteristics and clinical outcomes for patients during 2017-2019 were gleaned from the SRTR datasets. Poisson regression was used to estimate incidence rate ratios (IRRs) of waitlist mortality and transplantation in candidates and all-cause mortality and death-censored graft loss in recipients by frequency of frailty assessment.

*Results: Assessing frailty at evaluation was associated with lower waitlist mortality rate (always IRR=0.91,95%CI:0.84-0.99;sometimes=0.89,95%CI:0.83-0.96) and KT rate (always=0.94,95%CI:0.91-0.97;sometimes=0.88,95%CI:0.85-0.90); the associations with waitlist mortality rate (always=0.86,95%CI:0.74-0.99;sometimes=0.83,95%CI:0.73-0.94) and KT rate (always=0.82,95%CI:0.77-0.88;sometimes=0.92,95%CI:0.87-0.98) were stronger in older patients. Always assessing frailty at KT was associated with lower graft loss rate (IRR=0.71,95%CI:0.54-0.92) but not with mortality (IRR=0.93,95%CI:0.76-1.13).

*Conclusions: Assessing frailty at evaluation is associated with lower KT rate but better waitlist survival rate, particularly in older candidates; centers always assessing frailty at admission are likely to have better graft survival rate. Transplant centers may utilize frailty assessments as a tool to better allocate health care resources for patients identified as frail, particularly for older patients.

To cite this abstract in AMA style:

Chen X, Liu Y, Thompson V, Chu NM, King EA, Walston JD, Kobashigawa JA, Dadhania DM, Segev DL, McAdams-DeMarco MA. Transplant Centers That Assess Frailty as Part of Clinical Practice Have Better Outcomes [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/transplant-centers-that-assess-frailty-as-part-of-clinical-practice-have-better-outcomes/. Accessed May 30, 2025.

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