Frailty impact on kidney transplantation in older people
File(s)
Published online version
Author(s)
Type
Journal Article
Abstract
Introduction
Kidney transplantation (KT) is increasing in older people. This cohort are vulnerable to frailty, which affects KT outcomes. This study investigated the impact of frailty on quality of life (QoL) and clinical outcomes in older KT candidates and recipients, improving understanding in this population specifically.
Methods
KT in Older People (KTOP): Impact of Frailty on Outcomes was a prospective, single-center, longitudinal, observational study. Older people (aged ≥ 60 years) listed for KT were recruited. Frailty was assessed using the Edmonton Frail Scale (EFS). Patient-reported outcomes (PROs) were evaluated using validated questionnaires. Waitlist and KT clinical outcomes were recorded. Descriptive, comparative, and mixed-effect analyses were used to determine PRO and clinical outcome variation by frailty.
Results
Two hundred ten participants were recruited, of which 120 were transplanted. At recruitment, 17.2% were frail and 19.4% were vulnerable. Frailty was associated with poorer PROs after KT across all questionnaires. Vulnerable/frail recipients experienced worsening symptom burden, mental QoL, and depression. Nonfrail recipients experienced early physical and mental QoL declines. Both groups reported improved treatment satisfaction and illness intrusiveness. Delayed graft function, 12-month graft function, and KT length-of-stay (LoS) were poorer in vulnerable/frail recipients. On the waitlist, nonfrail participants reported stable PROs, whereas vulnerable/frail participants experienced fluctuations, more infection events, and longer suspensions.
Conclusion
The KTOP study provides a detailed, holistic, and longitudinal description of frailty’s influence throughout the KT journey in older people. These findings are crucial to enabling more accurate discussions, better shared decision-making, and targeted interventions and clearer goals of KT to be determined.
Kidney transplantation (KT) is increasing in older people. This cohort are vulnerable to frailty, which affects KT outcomes. This study investigated the impact of frailty on quality of life (QoL) and clinical outcomes in older KT candidates and recipients, improving understanding in this population specifically.
Methods
KT in Older People (KTOP): Impact of Frailty on Outcomes was a prospective, single-center, longitudinal, observational study. Older people (aged ≥ 60 years) listed for KT were recruited. Frailty was assessed using the Edmonton Frail Scale (EFS). Patient-reported outcomes (PROs) were evaluated using validated questionnaires. Waitlist and KT clinical outcomes were recorded. Descriptive, comparative, and mixed-effect analyses were used to determine PRO and clinical outcome variation by frailty.
Results
Two hundred ten participants were recruited, of which 120 were transplanted. At recruitment, 17.2% were frail and 19.4% were vulnerable. Frailty was associated with poorer PROs after KT across all questionnaires. Vulnerable/frail recipients experienced worsening symptom burden, mental QoL, and depression. Nonfrail recipients experienced early physical and mental QoL declines. Both groups reported improved treatment satisfaction and illness intrusiveness. Delayed graft function, 12-month graft function, and KT length-of-stay (LoS) were poorer in vulnerable/frail recipients. On the waitlist, nonfrail participants reported stable PROs, whereas vulnerable/frail participants experienced fluctuations, more infection events, and longer suspensions.
Conclusion
The KTOP study provides a detailed, holistic, and longitudinal description of frailty’s influence throughout the KT journey in older people. These findings are crucial to enabling more accurate discussions, better shared decision-making, and targeted interventions and clearer goals of KT to be determined.
Date Issued
2025-08-13
Date Acceptance
2025-08-05
Citation
Kidney International Reports, 2025
ISSN
2468-0249
Publisher
Elsevier
Journal / Book Title
Kidney International Reports
Copyright Statement
© 2025 International Society of Nephrology. Published by Elsevier Inc. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Publication Status
Published online
Date Publish Online
2025-08-13