Kidney transplantation in older people: impact of frailty on outcomes
File(s)
Author(s)
Thind, Amarpreet
Type
Thesis
Abstract
Kidney transplantation (KT) in older people has increased, however older people with kidney
disease are vulnerable to frailty and cognitive impairment, which impacts on KT outcomes. In
this cohort quality of life (QoL) changes from KT are a greater consideration than survival.
Achieving a better understanding of waitlist (WL) and KT experiences, and variation with frailty
is therefore crucial to guiding KT discussions and decision-making.
This thesis presents work conducted in the Kidney Transplantation in Older People (KTOP):
impact of frailty on outcomes study. KTOP was a prospective, single-centre, longitudinal study
where older people (aged ³60) on the WL were recruited. Questionnaires assessing frailty,
cognition, QoL and patient experience were completed, alongside clinical event and WL
activity data collection.
Two hundred and ten participants were recruited, 118 of whom were transplanted. At
recruitment 37.4% had cognitive impairment, 17.2% were frail, and 19.4% were vulnerable to
frailty. On the WL most participants maintained the same frailty status, whilst following KT
frailty initially declined before slowly recovering.
A trend towards poorer WL and KT clinical outcomes in vulnerable/frail participants was
observed, including more major infection events and longer suspension from the WL, and
more delayed graft function following KT.
Throughout poorer QoL and patient experiences were reported as identified frailty status
worsened. On the WL and following KT not frail participants reported stability in their
experiences, whilst vulnerable/frail participants reported fluctuating experiences. All recipients
experienced a mental QoL decline following KT, but improved treatment satisfaction and
illness intrusion. A qualitative study was established to explore the lived experiences in
vulnerable/frail participants further.
These findings provide a holistic description of KT in older people and demonstrate that frailty
assessment is crucial to improving older peoples’ care. Utilising this information enables
tailored counselling, decision-making, expectation management, and support for older people
to be achieved.
disease are vulnerable to frailty and cognitive impairment, which impacts on KT outcomes. In
this cohort quality of life (QoL) changes from KT are a greater consideration than survival.
Achieving a better understanding of waitlist (WL) and KT experiences, and variation with frailty
is therefore crucial to guiding KT discussions and decision-making.
This thesis presents work conducted in the Kidney Transplantation in Older People (KTOP):
impact of frailty on outcomes study. KTOP was a prospective, single-centre, longitudinal study
where older people (aged ³60) on the WL were recruited. Questionnaires assessing frailty,
cognition, QoL and patient experience were completed, alongside clinical event and WL
activity data collection.
Two hundred and ten participants were recruited, 118 of whom were transplanted. At
recruitment 37.4% had cognitive impairment, 17.2% were frail, and 19.4% were vulnerable to
frailty. On the WL most participants maintained the same frailty status, whilst following KT
frailty initially declined before slowly recovering.
A trend towards poorer WL and KT clinical outcomes in vulnerable/frail participants was
observed, including more major infection events and longer suspension from the WL, and
more delayed graft function following KT.
Throughout poorer QoL and patient experiences were reported as identified frailty status
worsened. On the WL and following KT not frail participants reported stability in their
experiences, whilst vulnerable/frail participants reported fluctuating experiences. All recipients
experienced a mental QoL decline following KT, but improved treatment satisfaction and
illness intrusion. A qualitative study was established to explore the lived experiences in
vulnerable/frail participants further.
These findings provide a holistic description of KT in older people and demonstrate that frailty
assessment is crucial to improving older peoples’ care. Utilising this information enables
tailored counselling, decision-making, expectation management, and support for older people
to be achieved.
Version
Open Access
Date Issued
2023-12
Date Awarded
2024-09
Copyright Statement
Creative Commons Attribution NonCommercial Licence
License URL
Advisor
Willicombe, Michelle
Brown, Edwina
Sponsor
Kidney Research UK
Stoneygate Trust
Grant Number
KS_RP_012_20180914
Publisher Department
Department of Immunology and Inflammation
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)