Kidney transplantation in older people: impact of frailty on outcomes

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.