Frailty and post-transplant adverse outcomes among kidney transplant recipients

Introduction: Frailty is a good predictor of adverse outcomes among older patients, especially those who have undergone surgery. The prevalence of frailty among kidney transplant candidates is higher than the general population. This study aimed to explore the predictive value of frailty on post-transplant adverse outcomes among kidney recipients. Methods: A systematic review was performed for relevant studies until May 20, 2022, using four databases (Embase, Medline, Cochrane, and PsycINFO) for prospective design studies (PROSPERP: CRD42022331022). Random-effect meta-analysis modeling was undertaken in RevMan 5.3 to estimate the predicting value of frailty on adverse outcomes after kidney transplant. Results: This systematic review included 14 studies, eight of which were suitable for meta-analysis. Frailty increased the risk of mortality (pooled hazard ratio HR 1.98, 95% confidence interval CI 1.48–2.64), surgical complications (risk ratio RR 2.14, 95% CI 1.01–4.54), death-censored graft failure (DCGF) (pooled HR 3.31, 95% CI 1.27–8.62), length of stay (LOS) (pooled RR 1.59, 95% CI 1.05–2.39), length of stay ≥2 weeks (pooled odds ratio OR 1.72, 95% CI 1.26–2.35). and other common adverse outcomes among kidney transplant recipients. Conclusions: Frailty is associated with adverse outcomes after kidney transplant. This systematic review suggests the importance of assessing frailty among kidney transplant candidates prior to transplantation. Further research focusing on pretransplant assessment combined with frailty is warranted to improve kidney transplant management.