A standard frailty indicator for predicting postoperative complications after kidney transplantation

---

L. Schopmeyer, M. El Moumni, G.J. Nieuwenhuijs-Moeke, S.P. Berger, S.J Bakker, R.A. Pol

Chair(s): dr. M.H.L. Christiaans & dr. R.J. Toorop

Thursday 9 march 2017

8:12 - 8:24h at Johan de Meesterzaal

Categories: Parallel - Klinisch

Parallel session: Parallelsessie XI – Klinisch 3 - Early Bird sessie 2

---

Currently there is a lack of tools that help predict the 30-day post-surgery outcome after kidney transplantation. Frailty is a clinically recognizable condition, also called syndrome or phenotype, that estimates physiologic reserves resulting from aging-associated processes. These changes are responsible for an increased vulnerability and decreased ability to cope with physical stressors, resulting in a serious deterioration in health. Frailty has recently emerged as a possible predictive factor for post-surgical outcomes.

This study aims to assess whether frailty is a reliable tool for predicting short term (30 days) postoperative complications after kidney transplantation with the aim to optimize treatment decisions and preventive arrangements.

From January 2015 to October 2016 all kidney transplant recipients (N=150) were prospectively included. At admission, frailty was assessed using a standardized frailty indicator consisting of 15 items, classified in 8 separate groups, consistent with the domains of functioning. Frailty was defined as a score ≥ 4 on the frailty scale ranging from 0 to 15. Postoperative complications were recorded and analysed using the Comprehensive Complication Index (CCI). Using a linear regression model, the correlation between 30-day postoperative complications and frailty was adjusted for important confunders and risk factors like sex, age, ASA Score, Charlson Comorbidty Index, hypertension, BMI, smoking, dialysis, duration of dialysis, type of transplantation and retransplantation.

The mean frailty score for the tested population was 2.07 and 23 patients had a frailty score of 4 or higher. The mean CCI score for 30-day post-surgery was 17.9; the mean CCI score for “frail” patients (≥ 4) was 30.1 compared to 15.5 for “non frail” patients (<4). Frailty (13.4 point increase in CCI, 95% CI: 5.5-21.3; p=0.001) and type of transplantation (10.5 point increase in CCI for postmortal transplantations, 95% CI: 0.5-20.5; p=0.04) were statistically significant factors associated with a higher risk of postoperative complications after kidney transplantation, independent of potential confounders.

In conclusion, frailty and type of transplantation are both factors significantly associated with 30-day postoperative complications measured by the CCI. The simplicity of determining frailty using a standardized frailty indicator makes it well applicable in daily clinical practice and can improve short and possibly long-term outcome.