An Overview of Frailty in Kidney Transplantation

Measurement, Management and Future Considerations

Meera N. Harhay; Maya K. Rao; Kenneth J. Woodside; Kirsten L. Johansen; Krista L. Lentine; Stefan G. Tullius; Ronald F. Parsons; Tarek Alhamad; Joseph Berger; XingXing S. Cheng; Jaqueline Lappin; Raymond Lynch; Sandesh Parajuli; Jane C. Tan; Dorry L. Segev; Bruce Kaplan; Jon Kobashigawa; Darshana M. Dadhania; Mara A. McAdams-DeMarco


Nephrol Dial Transplant. 2020;35(7):1099-1112. 

In This Article


In this review we discussed the evidence that frailty is highly prevalent among individuals before and after KT, with implications for post-KT outcomes and the need for future research on interventions and access to KT (Table 3). Many tools exist that may assist clinicians in identifying KT candidates and recipients who are uniquely vulnerable to health stressors. However, research is needed to compare the discriminatory ability of existing frailty metrics for monitoring patient-oriented KT outcomes. A harmonized dynamic measure that captures decreased physiologic reserve in ESKD patients may be needed. Furthermore, the preponderance of evidence suggests that frailty is an independent and commonly unmeasured risk factor for numerous adverse outcomes among KT candidates and recipients, underscoring the urgent need to prospectively evaluate the impact of targeted frailty interventions (e.g. structured exercise, physical therapy and dietician support) on access to KT and post-KT outcomes. Finally, although pre- and post-KT outcomes among frail individuals are worse than outcomes among nonfrail peers, KT may still provide survival and quality-of-life benefits for many frail individuals compared with remaining on dialysis. Therefore we recommend that evidence of frailty should not be used to disqualify individuals from KT candidacy, but rather used to identify KT candidates that may require additional surveillance and support before and after KT.