Kidney Week

Abstract: SA-OR001

Frailty and Age Disparities in Access to Kidney Transplantation

Session Information

• Access, Organ Utilization, and Infectious Disease
  October 27, 2018 | Location: 24A, San Diego Convention Center
  Abstract Time: 04:30 PM - 04:42 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Haugen, Christine E., Johns Hopkins Hospital, Baltimore, Maryland, United States

Christine E. Haugen, MD

• Bowring, Mary Grace, Johns Hopkins Hospital, Baltimore, Maryland, United States

Mary Grace Bowring,

• Holscher, Courtenay M., Johns Hopkins University, Baltimore, Maryland, United States

Courtenay M. Holscher,

• Ying, Hao, Johns Hopkins School of Medicine, Baltimore, Maryland, United States

Hao Ying,

• Brennan, Daniel C., Johns Hopkins, Baltimore, Maryland, United States

Daniel C. Brennan,

• Desai, Niraj, Physician, Baltimore, Maryland, United States

Niraj Desai,

• Garonzik wang, Jacqueline, Johns Hopkins, Baltimore, Maryland, United States

Jacqueline Garonzik wang,

• Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States

Dorry L. Segev,

• McAdams-DeMarco, Mara, Johns Hopkins, Baltimore, Maryland, United States

Mara McAdams-DeMarco,

Background

Older age is a known barrier to kidney transplantation (KT). One mechanism to explain age disparities is frailty, a decreased physiologic response to stressors associated with poor outcomes after KT.

Methods

We studied 3,548 KT candidates (2009-2017) in a multi-center cohort study of frailty. We estimated time to listing, waitlist mortality, and transplant rate using Cox proportional hazards, competing risks, and Poisson regression.

Results

The association between KT listing and candidate age varied by frailty status (interaction p=0.03): Older (age≥65) frail candidates were 27% less likely to be listed compared to older nonfrail candidates (aHR:0.73,95%CI:0.59-0.92,p<0.01), whereas younger (age:18-64) frail candidates were 23% less likely to be listed for KT (aHR:0.77,95%CI:0.68-0.88,p<0.001) (Figure 1A). Both older (aSHR:1.97,95%CI:1.54-2.53,p<0.001) and frail (aSHR:1.38,95%CI:1.05-1.83, p=0.02) KT candidates had higher waitlist mortality; but there was no synergistic effect (interaction p=0.12) (Figure 1B). The association between candidate age and transplant rate differed by frailty status (interaction p=0.02): younger frail KT candidates were transplanted less frequently than younger nonfrail candidates (aIRR:0.68,95%CI:0.55-0.83,p<0.001). However, older frail KT candidates had similar transplant rates to older nonfrail candidates (aIRR:1.12,95%CI0.78-1.61,p=0.5) (Figure 1C).

Conclusion

The synergistic effect of older age and frailty is associated with a lower chance of listing, but not seen in older frail candidates with regards to waitlist mortality. Frailty assessment at KT evaluation can help guide patient counseling for candidates all of all ages, and prehabilitation strategies to improve pre-KT outcomes.

Funding

• NIDDK Support