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The Alliance Spotlight Series is a recurring one-page publication for front-line healthcare professionals, offering quick-takes on critical topics affecting the field of organ donation and transplantation. We encourage you to download these issues and share them with your front-line colleagues and partners.

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Doctor Discussing Records With Senior Female Patient Smiling
A Crucial Component of the Patient Evaluation

Frailty Among Kidney Transplant Recipients

What is the Clinical Definition of Frailty?

The frailty phenotype is a multi-component syndrome in which three or more of the following criteria are met:Frailty Image

  • Unexplained weight loss
  • Decreased walking speed
  • Decreased grip strength
  • Low physical activity
  • Exhaustion

Are Frail Kidney Transplant Candidates at Risk of Poor Outcomes?

Kidney Transplant Candidates, regardless of age, are highly vulnerable to adverse events while awaiting a transplant. In kidney transplant candidates, frailty is associated with increased odds of fair or poor HRQOL (Health-Related Quality of Life) at the time of evaluation.
Frail candidates have the steepest decline in HRQOL while waiting for a kidney transplant. Additionally, these candidates are at an increased risk of waitlist mortality.

Are Frail Kidney Transplant Recipients at Risk of Poor Outcomes?

Recipients who are frail are at high risk for adverse post-KT outcomes. When measured at the time of admission for KT, frailty is associated with increased risk of longer length of stay (2+ weeks), post-transplant delirium, early hospital readmission within 30 days of discharge, delayed graft function, MMF (mycophenolate mofetil) intolerance, and mortality.

Which Kidney Transplant Recipients are Likely to Become Frail?


Frailty Assessments Help Improve Recipient Selection

Incorporating a frailty assessment into the kidney transplant evaluation aids transplant surgeons in:

  • Accepting marginal candidates who are robust
  • Deciding against transplanting candidates who will not tolerate transplantation
  • Identifying older patients who will benefit from transplant despite their age
  • Identifying candidates who may need prehabilitation

Helpful Resources

McAdams-DeMarco, M., Olorundare, I., Ying, H., Warsame, F., Haugen, C., Hall, R., GaronzikWang, J., Desai, N., Walston, J., Norman, S. and Segev, D. (2018). Frailty and Post Kidney Transplant Health-Related Quality of Life. Transplantation, 102(2), pp.291-299.

Fried, L., Tangen, C., Walston, J., Newman, A., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W., Burke, G. and McBurnie, M. (2001). Frailty in Older  Adults: Evidence for a Phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(3), pp.M146-M157.

McAdams-DeMarco, M., Ying, H., Olorundare, I., King, E., Haugen, C., Buta, B., Gross, A., Kalyani, R., Desai, N., Dagher, N., Lonze, B., Montgomery, R., Bandeen-Roche, K., Walston, J. and Segev, D. (2017). Individual Frailty Components and Mortality in Kidney Transplant Recipients. Transplantation, 101(9),  pp.2126-2132.

McAdams-DeMarco, M., Law, A., King, E., Orandi, B., Salter, M., Gupta, N., Chow, E., Alachkar, N., Desai, N., Varadhan, R., Walston, J. and Segev, D. (2014). Frailty and Mortality in Kidney Transplant Recipients. American Journal of Transplantation, 15(1), pp.149-154.

Webinar recording: Frailty Assessment: A Crucial Component of the Kidney Transplant Candidate Evaluation

Questions & Comments

Please send all questions and/or feedback to

Content derived from a webinar presentation by Mara McAdams DeMarco.

Worth Sharing
Education Corner Vol IV Issue 7

A Special Thanks to This Series’ Contributors

Mara Mcadams Demarco
Mara McAdams DeMarco
Associate Professor and Director of Surgical and Outcomes Research
Johns Hopkins
DD6A2041 JD Edited
About the Editor |
Corey Bryant

Corey Bryant brings more than 15 years of communications experience to The Alliance, having served in communications and public relations roles for Disney Parks and Resorts, Disney Cruise Line and TransLife (now OurLegacy), the OPO serving East Central Florida. He has also been an active board member of Donate Life Florida, having served as state team leader for Driver License Outreach. Corey is a proud alum of The University of Alabama and serves on the board of directors for Come Out With Pride Orlando as well as Five Horizons Health Services, a not-for-profit organization providing access to progressive HIV testing, prevention and LGBT+ focused healthcare throughout West Alabama and East Mississippi.

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