Kidney Week

Abstract: FR-PO0981

Association of Pretransplant Functional Status Assessed by Karnofsky Performance Score with Mortality in Kidney Transplant Recipients

Session Information

• Transplantation: Clinical - Pretransplantation, Living Donation, and Policies
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Tantisattamo, Ekamol, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, United States

Ekamol Tantisattamo, MD, MPH, FASN

• Mohpichai, Nopavit, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, United States

Nopavit Mohpichai

• Yongkiatkan, Panchanit, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Panchanit Yongkiatkan, MD

• Bunyawannukul, Issaree, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, United States

Issaree Bunyawannukul, MD

• Wongmat, Napat, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Napat Wongmat, MD

• Wareesawetsuwan, Nicha, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Nicha Wareesawetsuwan, MD

• Puyati, Weerinth, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Weerinth Puyati, MD

• Noree, Wanprapit, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Wanprapit Noree, MD

• Chamnarnphol, Natanon, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Natanon Chamnarnphol, MD

• Kim, Seonghyeon, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Seonghyeon Kim

• Gangeddula, Vishwaas Reddy, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Vishwaas Reddy Gangeddula

• Massihians, Monique, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Monique Massihians

• Lapadjyan, Mary E, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Mary E Lapadjyan

• Shahnazarian, Christine T, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Christine T Shahnazarian

• Liu, Yangjiayi, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Yangjiayi Liu

• Ghaffarian, Bahaar S, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Bahaar S Ghaffarian

• Ho, Meghan Y, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Meghan Y Ho, MPH

• Sibia, Gurleen Kaur, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Gurleen Kaur Sibia

• Kookanok, Chutawat, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Chutawat Kookanok, MD

• Kulthamrongsri, Narathorn, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Narathorn Kulthamrongsri, MD

• Wattanachayakul, Phuuwadith, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Phuuwadith Wattanachayakul, MD

• Supapwanich, Palakorn, Excellent Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Palakorn Supapwanich, MD

• Lee, Kyung hee, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, United States

Kyung hee Lee, MD

• Arpornsujaritkun, Nuttapon, Excellent Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Nuttapon Arpornsujaritkun, MD

• Kantachuvesiri, Surasak, Excellent Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Surasak Kantachuvesiri, MD

Background

Functional status is associated with kidney transplant (KT) outcomes. Karnofsky Performance Score (KPS) is utilized to assess the functional status of KT candidates. However, its utility in predicting long-term post-KT outcomes is unclear. We aim to examine the association between pre-KT KPS and mortality of kidney transplant recipients (KTR).

Methods

A retrospective cohort study utilizing data from OPTN/SRTR included patients undergoing KT between 10/1/1987 and 12/31/2024. Pre-KT KPS were categorized into 5 groups (≤50%, 60%, 70%, 80%, and ≥90%). The association between the KPS and time-to-death was examined by multiple Cox regression.

Results

Of 139,502 adult KTR with available pre-KT KPS, the mean±SD age was 54±14 years, and 62% were male. The majority had a KPS of ≥90%, while the smallest group was those with a KPS of 60%. During the median follow-up of 2.05 years, 33,088 KTR died. The incidence rate of all-cause mortality was 0.09 person-years. Compared to KTR with the KPS ≤50%, patients with higher KPS had a graded decline in mortality (HR_{KPS 60, 70, 80, ≥90%} 0.47, 0.30, 0.21, and 0.14; P <0.0001). After adjusting for age, gender, ethnicity, obesity, diabetes and PVD status, pre-KT proteinuria, serum albumin, dialysis vintage, donor type, KDPI, A-B-DR and total HLA mismatches, total cPRA, history of DGF and acute rejection, KTR in all KPS groups still had significantly lower mortality rate than KTR in the lowest KPS group (adjusted HR_{KPS 60, 70, 80, ≥90%} 0.41, 0.27, 0.19, and 0.13; P <0.0001). Age was an effect modifier with a higher mortality rate observed in KTR with KPS of 80% and ≥90% whose age is ≥75 years old (P_{interaction KPS 80 and ≥90%} <0.0001).

Conclusion

Pre-KT KPS is inversely associated with mortality in KTR, especially in those ≥75 years old with high KPS. In addition to functional status assessment, age remains a factor that modifies the KPS–mortality association in KTR.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025syspfdpk