Frailty in kidney transplant candidates is associated with reduced likelihood of transplantation

Background: Kidney transplantation is the optimal treatment for kidney failure; however, it represents a major physiological stress. Frailty is a clinical syndrome also characterized by decreased physiological reserve and a reduced ability to cope with stressor events. The aim of this study was to assess the association between frailty status and the likelihood of undergoing kidney transplantation. Methods: This retrospective observational study included all kidney transplant candidates waitlisted at the Kidney Transplant Center of the Parma University Hospital, Italy, between July 2018 and February 2020. Frailty status was assessed using the Fried Frailty Phenotype. Frailty was defined as a Fried frailty phenotype score ≥3, while a score of 1 or 2 indicated a pre-frail condition. The Aalen-Johansen estimator was used to estimate the cumulative probability of transplantation and death/withdrawal according to frailty status (frail vs non-frail). Adjusted analyses were performed using Fine-Gray multivariable regression models. Results: Of the 171 patients enrolled, 39% were non-frail, 51% were pre-frail, and 10% were frail. Patients were followed for a median of 17 months; during this period, 42% underwent transplantation, whereas 6% died or were permanently removed from the waiting list. In adjusted analyses, frail and pre-frail patients combined had a 42% lower likelihood of undergoing transplantation compared with non-frail patients (SubHR 0.58, 95% CI 0.39-0.86; P = .006). Conclusions: Frailty among patients with advanced CKD on the kidney transplant waiting list was associated with a lower probability of undergoing transplantation.