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:
- 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
