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
| Outcome | Not Frail | Vulnerable/Frail | p Value |
| WL mortality | 10 (22.2%) | 14 (31.1%) | 0.340 |
| WL major infection episode | 11 (24.4%) | 27 (60%) | 0.001 |
| WL total time suspended (days) (mean, ±SD) | 307 (244) | 434 (295) | 0.0246 |
| KT mortality | 5 (7%) | 8 (18.2%) | 0.0774 |
| All cause graft loss | 7 (9.9%) | 10 (29.4%) | 0.0588 |
| KT major infection episode | 39 (54.9%) | 29 (69%) | 0.138 |
| Hospitalised in 1sy year after KT | 37 (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 |