Background

There is an increasing incidence and prevalence of older adults with ESRD. Per guideline recommendations, many of these patients are now being considered for kidney transplant. At the University of Chicago, we have developed a geriatric assessment clinic for all older patients referred for kidney transplant. The results of this assessment are presented to the transplant multidisciplinary team to determine patient suitability for transplant.

Methods

Retrospective observational data collection of adults age >50 seen for pre-kidney transplant geriatric assessment in 2012-2016.

Results

Between January 1, 2012 and January 1, 2016, 173 patients underwent pre-transplant geriatric assessment to evaluate for suitability for kidney transplant. Of the patients who were evaluated, 119 had complete evaluation and waitlist status. Mean age was 71.01 (SD 4.66). A majority of patients were male n= 100 (57.8%) and non-white n= 130 (75.1%). Patients had multiple comorbidities including peripheral vascular disease n=24 (17.1%), congestive heart failure n=16 (11.4%), coronary artery disease n=43 (30.7%), hypertension n=120 (85.7%), diabetes n=88 (62.9%), atrial fibrillation n=19 (13.6%), and a history of malignancies n=18 (12.9%). Geriatric assessment for cognition used the Mini-Mental State Exam score mean 27 (SD 2) , for mood used the Geriatric Depression Scale, mean score 1 (SD 2), and for gait speed in seconds per 10 ft with normal speed < 10 seconds n=95 (81.9%), moderate slowing 11-15 seconds n=12 ( 10.3%) and severe slowing >15 seconds n=9 (7.8%). Recommendations made from the first evaluation based on medical comorbidities and geriatrics assessment were as follows: good candidate n=68, fair candidate n=3, and poor candidate n=11. Currently, 35 patients (29.4%) are active on the waitlist or have been transplanted.

Conclusion

We have successfully integrated a geriatric assessment model of care into the evaluation process for kidney transplant for all older adults at the University of Chicago. Most patients being referred for geriatric assessment are considered appropriate for kidney transplant. Patients are followed annually to identify changes in health, functional, or cognitive status and reassessment for appropriateness for transplant.

CITATION INFORMATION: Campbell K, Enger F, Patrick E, Saunders M, Josephson M, Becker Y. Use of Modified Geriatric Assessment in Evaluation of Older Adults for Kidney Transplant Suitability. Am J Transplant. 2017;17 (suppl 3).

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