Frailty Impact on Kidney Transplantation in Older People

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.