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 2017, members from the American Society of Transplantation (AST) Kidney Pancreas Community of Practice (KPCOP) formed a Frailty Work Group with the goal of summarizing the current literature on frailty metrics, the impact of frailty on end-stage kidney disease (ESKD) and KT populations and potential interventions and areas for additional research. This project was part of a larger AST initiative to build consensus related to frailty measurement and care in solid organ transplantation.[4] We first conducted a PubMed search for literature on relevant topics in frailty, including search terms such as 'frail elderly', 'frail instrument' and 'kidney transplant'. Our search strategy yielded 641 unique articles. We supplemented this search with searches in the EMBASE, Community Index to Nursing and Allied Health Literature and Cochrane databases. An updated search of the PubMed database was also performed in April 2019. Members of the KPCOP Frailty Work Group were divided into six subgroups of three to four individuals who reviewed the literature on a specific subtopic and created a summary. The information was shared with the KPCOP Frailty Work Group via a series of teleconferences and web-based communications from August 2017 to February 2018. The products of the subgroups were collated into a single harmonized manuscript by three primary authors (M.N.H., M.K.R. and K.J.W.) and two senior authors (M.M.D. and D.M.D.). A complete draft was circulated to the work group for feedback and revision, resulting in the final review manuscript. All authors had continuous access to the working documents to provide input, critical review and revisions.