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Multicenter Study
. 2020 Apr;20(4):1170-1180.
doi: 10.1111/ajt.15709. Epub 2019 Dec 12.

Prevalence of frailty among kidney transplant candidates and recipients in the United States: Estimates from a National Registry and Multicenter Cohort Study

Christine E Haugen  1 , Alvin G Thomas  1 , Nadia M Chu  1   2 , Ashton A Shaffer  1   2 , Silas P Norman  3 , Adam W Bingaman  4 , Dorry L Segev  1   2 , Mara McAdams-DeMarco  1   2
Affiliations
Multicenter Study

Prevalence of frailty among kidney transplant candidates and recipients in the United States: Estimates from a National Registry and Multicenter Cohort Study

Christine E Haugen et al. Am J Transplant. 2020 Apr.

Abstract

Frailty, a measure of physiologic reserve, is associated with poor outcomes and mortality among kidney transplant (KT) candidates and recipients. There are no national estimates of frailty in this population, which may help patient counseling and resource allocation at transplant centers. We studied 4616 KT candidates and 1763 recipients in our multicenter prospective cohort of frailty from 2008-2018 with Fried frailty measurements. Using Scientific Registry of Transplant Recipients (SRTR) data (KT candidates = 560 143 and recipients = 243 508), we projected the national prevalence of frailty (for KT candidates and recipients separately) using standardization through inverse probability weighting, accounting for candidate/recipient, donor, and transplant factors. In our multicenter cohort, 13.3% of KT candidates were frail at evaluation; 8.2% of LDKT recipients and 17.8% of DDKT recipients were frail at transplantation. Projected nationally, our modeling strategy estimated 91 738 KT candidates or 16.4% (95% confidence interval [CI] 14.4%-18.4%) of all KT candidates during the study period were frail, and that 34 822 KT recipients or 14.3% (95% CI 12.3%-16.3%) of all KT recipients were frail (LDKT = 8.2%; DDKT = 17.8%). Given the estimated national prevalence of frailty, transplant programs should consider assessing the condition during KT evaluation to improve patient counseling and resource allocation along with identification of recipients at risk for poor outcomes.

Keywords: Scientific Registry for Transplant Recipients (SRTR); clinical research/practice; kidney transplantation/nephrology; registry/registry analysis.

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Figures

Figure 1.
Figure 1.
Prediction model performance (AUC = 0.731) for frailty among kidney transplant recipients.
Figure 2.
Figure 2.
Number of (A) prefrail and (B) frail KT candidates by donor service area from 2000–2018.
Figure 3.
Figure 3.
Number of (A) prefrail and (B) frail kidney transplant recipients by donor service area from 2000–2018.
Figure 4.
Figure 4.
Number of (A) prefrail and (B) frail percentage difference from median transplant/candidate ratio to assess access to transplantation for among frail and nonfrail candidates from 2000–2018. The lowest access to transplant in frail candidates were in California, Texas, Alabama, and Georgia.
See this image and copyright information in PMC

References

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