Abstract
Introduction: Kidney transplantation (KT) in older people has increased with aging of the population with kidney failure (KF). Older people with KF are vulnerable to frailty, which affects KT outcomes. Achieving a better understanding of waitlist and KT experiences in older people and the variation with frailty is crucial for guiding discussions and decision making. This study investigated the impact of frailty on quality of life (QoL) and clinical outcomes in older KT recipients.
Methods: Kidney Transplantation in Older People (KTOP): impact of frailty on outcomes was a prospective, single-center, longitudinal study in which older people (aged 60 years) listed for KT were recruited. Frailty was assessed using the Edmonton Frail Scale. Patient-reported outcomes were evaluated using validated questionnaires. Waitlist and KT clinical outcomes were also recorded.
Results - 210 participants were recruited, of which 120 were transplanted. At recruitment, 17.2% were frail and 19.4% were vulnerable. Frailty was associated with poorer patient-reported outcomes (PRO) across all questionnaires after KT. Vulnerable/frail recipients experienced a worsening symptom burden, mental QoL, and depression post-KT. Non-frail recipients experienced early declines in physical and mental QoL. Both groups reported improved treatment satisfaction and illness intrusiveness with KT. Delayed graft function, 12-month graft function, and length of stay for KT were poorer in the vulnerable and frail recipients. On the waitlist, not-frail participants reported stability across most PROs, while vulnerable/frail participants experienced fluctuations, were more likely to experience major infection events, and had longer waitlist suspensions.
Conclusion: The KTOP study provides a novel, detailed, holistic description of KT in older people with varying degrees of frailty. Assessing frailty is crucial for older people to provide more accurate expectations, which will facilitate better shared decision-making and enable targeted interventions that may improve outcomes.
Methods: Kidney Transplantation in Older People (KTOP): impact of frailty on outcomes was a prospective, single-center, longitudinal study in which older people (aged 60 years) listed for KT were recruited. Frailty was assessed using the Edmonton Frail Scale. Patient-reported outcomes were evaluated using validated questionnaires. Waitlist and KT clinical outcomes were also recorded.
Results - 210 participants were recruited, of which 120 were transplanted. At recruitment, 17.2% were frail and 19.4% were vulnerable. Frailty was associated with poorer patient-reported outcomes (PRO) across all questionnaires after KT. Vulnerable/frail recipients experienced a worsening symptom burden, mental QoL, and depression post-KT. Non-frail recipients experienced early declines in physical and mental QoL. Both groups reported improved treatment satisfaction and illness intrusiveness with KT. Delayed graft function, 12-month graft function, and length of stay for KT were poorer in the vulnerable and frail recipients. On the waitlist, not-frail participants reported stability across most PROs, while vulnerable/frail participants experienced fluctuations, were more likely to experience major infection events, and had longer waitlist suspensions.
Conclusion: The KTOP study provides a novel, detailed, holistic description of KT in older people with varying degrees of frailty. Assessing frailty is crucial for older people to provide more accurate expectations, which will facilitate better shared decision-making and enable targeted interventions that may improve outcomes.
| Original language | English |
|---|---|
| Journal | Kidney International Reports |
| Publication status | Accepted/In press - 5 Aug 2025 |