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Kidney Week

Abstract: FR-PO900

Kidney Transplantation in Older People (KTOP): The Frail Experience

Session Information

  • Geriatric Nephrology
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1300 Geriatric Nephrology

Authors

  • Thind, Amarpreet Kaur, Imperial College London Faculty of Medicine, London, London, United Kingdom
  • Willicombe, Michelle, Imperial College London Faculty of Medicine, London, London, United Kingdom
  • Brown, Edwina A., Hammersmith Hospital, London, London, United Kingdom

Group or Team Name

  • KTOP Investigator Group.
Background

Older people with kidney failure are vulnerable to frailty. Understanding their experiences is integral to kidney transplantation(KT) decision making.

Methods

The KTOP:impact of frailty on outcomes study assessed frailty, quality of life(QoL), and clinical outcomes in people >60, on the waitlist(WL) and after KT. Mixed-effect analysis identified trends and frailty variations.

Results

210 patients were recruited;118 were transplanted. At recruitment 63.4%(118) were not frail, 19.4%(36) vulnerable, and 17.2%(32) frail. The study was powered only for QOL changes, but on the WL vulnerable/frail candidates were more likely to have major infections and spend longer suspended. After KT vulnerable/frail recipients were more likely to be hospitalised, have longer admissions, and possibly higher graft loss and mortality(table).

On the WL, QoL trends showed stable physical component scores(PCS) in not frail candidates and declining scores in vulnerable/frail. Post-KT not frail candidates PCS declined before slowly recovering, whilst PCS stabilised in vulnerable/frail. WL mental component scores (MCS) improved in both groups. MCS after KT declined then improved in not frail candidates, and worsened in vulnerable/frail(figure 1).

Conclusion

Frail/vulnerable older people had worse WL and KT clinical outcomes. KT did not change QoL hugely for either group, but trends varied by frailty. Achieving a holistic understanding will enable better assessment, counselling, and support for older people considering KT.

Clinical outcomes by frailty
OutcomeNot FrailVulnerable/Frailp Value
WL mortality10 (22.2%)14 (31.1%)0.340
WL major infection episode11 (24.4%)27 (60%)0.001
WL total time suspended (days) (mean, ±SD)307 (244)434 (295)0.0246
KT mortality5 (7%)8 (18.2%)0.0774
All cause graft loss7 (9.9%)10 (29.4%)0.0588
KT major infection episode39 (54.9%)29 (69%)0.138
Hospitalised in 1sy year after KT37 (52%)32 (73%)0.028
Total Length of stay in 1st year after KT (days) (mean, ±SD)20.5 (24.8)36.6 (32.7)0.0238