Increased mortality after kidney transplantation in mildly frail recipients
María José Pérez‐Sáez, Carlos E Arias-Cabrales, Dolores Redondo‐Pachón, Carla Burballa, Anna Buxeda, Anna Sofie Bach, Anna Faura, Ernestina Junyent, Ester Marco, Leocadio Rodríguez‐Mañas, Marta Crespo, Julio Pascual, for the FRAIL-MAR Study Group, María José Pérez‐Sáez, Carlos E Arias-Cabrales, Dolores Redondo‐Pachón, Francesc Barbosa, Higini Cao, Sílvia Collado, Anna Buxeda, Carla Burballa, Marta Crespo, Julio Pascual, Anna Faura, María Vera, Anna Sofie Bach, Guillermo Pedreira, Ernestina Junyent, Montserrat Folgueiras, Yolanda Castillo, Aida Aleyda Jiménez Martínez, Marisol Fernández, Eva Barbero, Rosa Causadías, Jesús Carazo, Lluís Cecchini, Ester Marco, Delky Meza de Valderrama, Andrea Morgado, Elena Muñoz, Xavier Nogués, Leocadio Rodríguez‐Mañas, Olga Castro, María Dolores Muns, Miguel Gárriz, María Polo Gómez, Sara Hurtado, Maite López-Sánchez, Laura Ribera, Margarita Guino, Ramón Roca, Jordi Calls, Alicia Rovira, Josep Ferrater Mora, Omar Ibrik, Florentina Liria, Thais Torralbo Lopez-Capp, Jaume Almirall, Carmen Moya, Fátima Moreno, Manel Ramírez de Arellano, Sandra Rubio, Ignacio Cidraque, Carlota Pájaro, Núria Garra, Josep Galcerán, Marina Fenollar, Sara Outón, Fabiola Dapena, Josep Jara, Rosa Garcı́a, Mònica Manresa
Abstract
Background: Physical Frailty Phenotype (PFP) is the most used frailty instrument among kidney transplant recipients, classifying patients as pre-frail if they have 1-2 criteria and as frail if they have ≥3. However, different definitions of robustness have been used among renal patients, including only those who have 0 criteria, or those with 0-1 criteria. Our aim was to determine the impact of one PFP criterion on transplant outcomes. Methods: We undertook a retrospective study of 296 kidney transplant recipients who had been evaluated for frailty by PFP at the time of evaluating for transplantation. Results: Only 30.4% of patients had 0 criteria, and an additional 42.9% showed one PFP criterion. As PFP score increased, a higher percentage of women and cerebrovascular disease were found. Recipients with 0-1 criteria had lower 1-year mortality after transplant than those with ≥2 (1.8% vs 10.1%), but this difference was already present when we only considered those who scored 0 (mortality 1.1%) and 1 (mortality 2.4%) separately. The multivariable analysis confirmed that one PFP criterion was associated to a higher risk of patient death after kidney transplantation [hazard ratio 3.52 (95% confidence interval 1.03-15.9)]. Conclusions: Listed kidney transplant candidates frequently show only one PFP frailty criterion. This has an independent impact on patient survival after transplantation.