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

Potential Roles for Frailty Metrics in Posttransplantation Settings: Grading Transplant Program Performance

Given the strong associations between frailty and adverse post-KT outcomes, frailty assessments may augment posttransplant clinical care and help providers to identify KT recipients who require additional support. Furthermore, the independent association between frailty and adverse post-KT outcomes has important implications in the regulation of US transplant program performance. Currently, program performance is graded based on risk-adjusted computations of expected 1-year patient and graft survival, and programs face serious consequences when recipient death and/or graft loss rates 'exceed expected'.[102] Frailty is not one of the risk factors used to adjust outcome expectations and this may serve as a disincentive for transplant programs to accept frail candidates for KT. Given the data that suggest frail candidates can receive survival and HRQOL benefits from KT, an important question is whether incorporation of frailty-based risk scores into program-specific reports could reduce disincentives for transplant programs to select frail individuals who may benefit from KT.[11]

The Organ Procurement and Transplantation Network (OPTN) already collects information on the Karnofsky Performance Score, a measure of self-reported or observed functional status that has been shown to enhance prediction of posttransplant survival.[103] However, the subjective nature of the Karnofsky Performance Score has rendered its inclusion in national risk adjustment (constructed by the Scientific Registry of Transplant Recipients with OPTN data) problematic, and it is no longer included in post-KT risk adjustment equations. Therefore, developing a consensus on objective instruments to measure frailty that can be widely implemented across transplant programs is an important goal for the future.[104]