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

Disclosures

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

In This Article

Imaging Studies, Morphometric Age and KT Outcomes

Whereas dedicated frailty instruments are not a uniform feature of KT candidate assessments, KT candidates often undergo cross-sectional imaging as part of their preoperative workup. In the general surgical literature, preoperative imaging has allowed for the quantification of interrelated concepts including sarcopenia, morphometric age and fat composition as potentially modifiable predictors of postoperative outcomes.[96–98] Sarcopenia, as measured by low psoas muscle cross-sectional area and density on computed tomography (CT), is associated with higher waiting list mortality in KT candidates,[99] but studies on postoperative outcomes are lacking. As opposed to chronologic age, older morphometric age, as quantified using CT-measured aortic calcifications, psoas muscle cross-sectional area and psoas muscle density, is associated with higher mortality among both kidney and liver transplant recipients.[100,101] Taken together, these results suggest that morphometric measurements may have a role in frailty assessment.

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