Frailty: A strong risk factor for dying prematurely after kidney transplant

Regardless of age, frailty is a strong risk factor for dying prematurely after a kidney transplant. The finding, which comes from a new study published in the American Journal of Transplantation, suggests that patients should be screened for frailty prior to kidney transplantation, and that those who are identified as frail should be closely monitored after the procedure.

It's very difficult for physicians to identify which patients with kidney disease will not do well after receiving a kidney transplant. Even the best models are able to correctly discriminate patients who died soon after the procedure from those who survived only slightly better than chance.

Because studies in patients undergoing various surgeries have found that frailty is linked with postoperative complications and other negative outcomes, Mara McAdams-DeMarco, PhD, of Johns Hopkins University's School of Public Health and School of Medicine, and her colleagues looked to see if frailty might also impact patients' survival after receiving a kidney transplant.

The researchers measured frailty in 537 kidney transplant recipients at the time of transplantation. At 5 years, the survival rates were 91.5 percent, 86.0 percent, and 77.5 percent for non-frail, intermediately frail, and frail kidney transplant recipients, respectively.

"Our results suggest that frail kidney transplant recipients are at twice the risk of mortality even after accounting for important recipient, transplant, and donor characteristics," said Dr. McAdams-DeMarco. "Our findings are important because frailty represents a unique domain of mortality risk that is not captured by recipient, transplant, or donor factors like recipient age, recipient comorbidity, or donor type, for example." She noted that frailty can easily be measured prior to transplantation to identify patients who may benefit from closer monitoring.