Kidney transplantation in older people (KTOP): a longitudinal, qualitative study of kidney transplant experiences in older, frail adults
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Background: Transplantation rates are increasing in those who are older and frail, driven by an aging dialysis population. This longitudinal, qualitative study explores how older adults navigate the journey from dialysis to transplantation and how frailty is experienced at each stage.
Methods: Twenty-one participants aged ≥60 years were recruited, all of whom were on dialysis awaiting kidney transplantation, with an Edmonton Frail Scale score of ≥6, indicating frailty or vulnerable to frailty. Participants were recruited from the larger observational cohort Kidney Transplantation in Older People (KTOP) study. Semi-structured interviews occurred across three timepoints: on dialysis; 3 months and 9-12 months post transplantation. Data were analysed through inductive thematic analysis.
Results: The experience of frailty persisted and did not improve from dialysis through to post transplantation. Covid added additional burden, pre and post-transplantation. This impacted on undertaking activities of daily living at all stages explored. Three months post transplantation, the recovery period was challenging with symptoms worse than those experienced during dialysis and with no improvement in frailty, which did not align with participant’s expectations. By 9-12 months post transplantation, several participants reported positive changes to life quality due to improved symptoms and dialysis-free time being spent connecting with loved ones. Frailty however persevered and was an added burden to living with a transplant and the limitations that entails e.g. medication regimens, reducing infection risk. Several personal, socio-cultural and education resources were identified as supportive to those with frailty on their transplant journey.
Conclusions: Healthcare professionals have a duty to engage older, frailer individuals on dialysis in preparatory discussions about the likely persistence of frailty into post transplantation life and the worsening symptoms at 3 months post transplantation. Together with this, healthcare professionals should discuss how the experience of frailty may be influenced by an individual’s personal, socio-cultural and education resources, namely the availability of support in activities of daily living and environmental adaptations, the presence of faith promoting psychological resilience, meaningful social interactions and health education to manage expectations post-transplantation.
Methods: Twenty-one participants aged ≥60 years were recruited, all of whom were on dialysis awaiting kidney transplantation, with an Edmonton Frail Scale score of ≥6, indicating frailty or vulnerable to frailty. Participants were recruited from the larger observational cohort Kidney Transplantation in Older People (KTOP) study. Semi-structured interviews occurred across three timepoints: on dialysis; 3 months and 9-12 months post transplantation. Data were analysed through inductive thematic analysis.
Results: The experience of frailty persisted and did not improve from dialysis through to post transplantation. Covid added additional burden, pre and post-transplantation. This impacted on undertaking activities of daily living at all stages explored. Three months post transplantation, the recovery period was challenging with symptoms worse than those experienced during dialysis and with no improvement in frailty, which did not align with participant’s expectations. By 9-12 months post transplantation, several participants reported positive changes to life quality due to improved symptoms and dialysis-free time being spent connecting with loved ones. Frailty however persevered and was an added burden to living with a transplant and the limitations that entails e.g. medication regimens, reducing infection risk. Several personal, socio-cultural and education resources were identified as supportive to those with frailty on their transplant journey.
Conclusions: Healthcare professionals have a duty to engage older, frailer individuals on dialysis in preparatory discussions about the likely persistence of frailty into post transplantation life and the worsening symptoms at 3 months post transplantation. Together with this, healthcare professionals should discuss how the experience of frailty may be influenced by an individual’s personal, socio-cultural and education resources, namely the availability of support in activities of daily living and environmental adaptations, the presence of faith promoting psychological resilience, meaningful social interactions and health education to manage expectations post-transplantation.
Date Acceptance
2026-08-03
Citation
BMC Nephrology
ISSN
1471-2369
Publisher
BMC
Journal / Book Title
BMC Nephrology
Copyright Statement
Subject to copyright. This paper is embargoed until publication. Once published the Version of Record (VoR) will be available on immediate open access.
Publication Status
Accepted