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Frailty and Long-Term Post-Kidney Transplant Outcomes

Current Transplantation Reports volume 6, pages 45–51 (2019)Cite this article

Abstract

Purpose of Review

To highlight recent research about frailty and its role as a predictor of adverse, long-term post-kidney transplant (KT) outcomes.

Recent Findings

Frailty is easily measured using the physical frailty phenotype (PFP) developed by gerontologist Dr. Linda Fried and colleagues. In recent studies, > 50% of KT recipients were frail (20%) or intermediately frail (32%) at KT admission. Frail recipients were at 1.3-times higher risk of immunosuppression intolerance and 2.2-times higher risk of mortality, even after accounting for recipient, donor, and transplant factors; these findings were consistent with those on short-term post-KT outcomes. Pilot data suggests that prehabilitation may be an intervention that increases physiologic reserve in frail KT recipients.

Summary

PFP is an effective tool to measure frailty in ESRD that improves risk stratification for short-term and long-term post-KT outcomes. Interventions to improve physiologic reserve and prevent adverse KT outcomes, particularly among frail KT recipients, are needed.

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Fig. 1

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Funding

This study was supported by the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) grant numbers: R01DK114074 (PI: McAdams-DeMarco), K24DK101828 (PI: Segev), and the National Institute on Aging (NIA) grant numbers: R01AG042504 (PI: Segev), K01AG043501 (PI: McAdams-DeMarco), and R01AG055781 (PI: McAdams-DeMarco). Mara A. McAdams-DeMarco was also supported by the Johns Hopkins University Claude D. Pepper Older Americans Independence Center (P30AG021334).

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Affiliations

  1. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Mara A. McAdams-DeMarco, Nadia M. Chu & Dorry L. Segev

  2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Mara A. McAdams-DeMarco, Nadia M. Chu & Dorry L. Segev

Authors
  1. Mara A. McAdams-DeMarco
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  2. Nadia M. Chu
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  3. Dorry L. Segev
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Correspondence to Mara A. McAdams-DeMarco.

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Mara McAdams-DeMarco, Nadia Chu, and Dorry Segev declare no conflict of interest.

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McAdams-DeMarco, M.A., Chu, N.M. & Segev, D.L. Frailty and Long-Term Post-Kidney Transplant Outcomes. Curr Transpl Rep 6, 45–51 (2019). https://doi.org/10.1007/s40472-019-0231-3

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Keywords

  • Frailty
  • Kidney transplantation
  • Epidemiology