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Frailty and mortality in kidney transplant recipients

McAdams-DeMarco, M A; Law, A; King, E; Orandi, B; Salter, M; Gupta, N; Chow, E; Alachkar, N; Desai, N; Varadhan, R; Walston, J; Segev, D L
We have previously described strong associations between frailty, a measure of physiologic reserve initially described and validated in geriatrics, and early hospital readmission as well as delayed graft function. The goal of this study was to estimate its association with postkidney transplantation (post-KT) mortality. Frailty was prospectively measured in 537 KT recipients at the time of transplantation between November 2008 and August 2013. Cox proportional hazards models were adjusted for confounders using a novel approach to substantially improve model efficiency and generalizability in single-center studies. We precisely estimated the confounder coefficients using the large sample size of the Scientific Registry of Transplantation Recipients (n = 37 858) and introduced these into the single-center model, which then estimated the adjusted frailty coefficient. At 5 years, the survivals were 91.5%, 86.0% and 77.5% for nonfrail, intermediately frail and frail KT recipients, respectively. Frailty was independently associated with a 2.17-fold (95% CI: 1.01-4.65, p = 0.047) higher risk of death. In conclusion, regardless of age, frailty is a strong, independent risk factor for post-KT mortality, even after carefully adjusting for many confounders using a novel, efficient statistical approach.
PMID: 25359393
ISSN: 1600-6143
CID: 5149902

Frailty and early hospital readmission after kidney transplantation

McAdams-DeMarco, M A; Law, A; Salter, M L; Chow, E; Grams, M; Walston, J; Segev, D L
Early hospital readmission (EHR) after kidney transplantation (KT) is associated with increased morbidity and higher costs. Registry-based recipient, transplant and center-level predictors of EHR are limited, and novel predictors are needed. We hypothesized that frailty, a measure of physiologic reserve initially described and validated in geriatrics and recently associated with early KT outcomes, might serve as a novel, independent predictor of EHR in KT recipients of all ages. We measured frailty in 383 KT recipients at Johns Hopkins Hospital. EHR was ascertained from medical records as ≥1 hospitalization within 30 days of initial post-KT discharge. Frail KT recipients were much more likely to experience EHR (45.8% vs. 28.0%, p = 0.005), regardless of age. After adjusting for previously described registry-based risk factors, frailty independently predicted 61% higher risk of EHR (adjusted RR = 1.61, 95% CI: 1.18-2.19, p = 0.002). In addition, frailty improved EHR risk prediction by improving the area under the receiver operating characteristic curve (p = 0.01) as well as the net reclassification index (p = 0.04). Identifying frail KT recipients for targeted outpatient monitoring and intervention may reduce EHR rates.
PMID: 23731461
ISSN: 1600-6143
CID: 5149852

Potential New High Infectious Risk Donor Categories: Results of a Systematic Review and Meta-Analysis [Meeting Abstract]

Kucirka, L; Weatherspoon, K; Van Arendonk, K; Montgomery, JR; Deshpande, N; Law, A; Bone, C; Montgomery, RA; Segev, D
ISI:000289318400572
ISSN: 1600-6135
CID: 1982932