Mara A McAdams-DeMarco1,2, Sarah E Van Pilsum Rasmussen1, Nadia M Chu1,2, Dayawa Agoons1, Ronald F Parsons3, Tarek Alhamad4, Kirsten L Johansen5, Stefan G Tullius6, Raymond Lynch3, Meera N Harhay7,8, Maya K Rao9, Joseph Berger10, Matthew Cooper11, Jane C Tan12, XingXing S Cheng12, Kenneth J Woodside13, Sandesh Parajuli14, Krista L Lentine15, Bruce Kaplan16, Dorry L Segev1,2, Jon A Kobashigawa17, Darshana Dadhania18. 1. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. 2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 3. Department of Surgery, Emory University School of Medicine, Atlanta, GA. 4. Division of Nephrology, Washington University in St. Louis, St. Louis, MO. 5. Division of Nephrology, Hennepin County Medical Center, Minneapolis, MN. 6. Department of Surgery, Division of Transplant Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 7. Department of Medicine, Division of Nephrology, Drexel University College of Medicine, Philadelphia, PA. 8. Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA. 9. Division of Nephrology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY. 10. Division of Nephrology, University of Texas Southwestern Medical School, Dallas, TX. 11. Department of Surgery, Georgetown University School of Medicine, Washington, DC. 12. Department of Medicine, Division of Nephrology, Stanford University, Stanford, CA. 13. Department of Surgery, Medical School, University of Michigan, Ann Arbor, MI. 14. Department of Medicine, Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI. 15. Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO. 16. Baylor Scott and White Health, Temple, TX. 17. Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA. 18. Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY.
Abstract
BACKGROUND: Given the potential utility of frailty, a clinical phenotype of decreased physiologic reserve and resistance to stressors, to predict postkidney transplant (KT) outcomes, we sought to understand the perceptions and practices regarding frailty measurement in US KT programs. METHODS: Surveys were emailed to American Society of Transplantation Kidney/Pancreas Community of Practice members and 202 US transplant programs (November 2017 to April 2018). Program characteristics were gleaned from Scientific Registry of Transplant Recipients. RESULTS: The 133 responding programs (response rate = 66%) represented 77% of adult KTs and 79% of adult KT candidates in the United States. Respondents considered frailty to be a useful concept in evaluating candidacy (99%) and endorsed a need to develop a frailty measurement specific to KT (92%). Frailty measurement was more common during candidacy evaluation (69%) than during KT admission (28%). Of the 202 programs, 38% performed frailty assessments in all candidates while 23% performed assessments only for older candidates. There was heterogeneity in the frailty assessment method; 18 different tools were utilized to measure frailty. The most common tool was a timed walk test (19%); 67% reported performing >1 tool. Among programs that measure frailty, 53% reported being less likely to list frail patients for KT. CONCLUSIONS: Among US KT programs, frailty is recognized as a clinically relevant construct and is commonly measured at evaluation. However, there is considerable heterogeneity in the tools used to measure frailty. Efforts to identify optimal measurement of frailty using either an existing or a novel tool and subsequent standardization of its measurement and application across KT programs should be considered.
BACKGROUND: Given the potential utility of frailty, a clinical phenotype of decreased physiologic reserve and resistance to stressors, to predict postkidney transplant (KT) outcomes, we sought to understand the perceptions and practices regarding frailty measurement in US KT programs. METHODS: Surveys were emailed to American Society of Transplantation Kidney/Pancreas Community of Practice members and 202 US transplant programs (November 2017 to April 2018). Program characteristics were gleaned from Scientific Registry of Transplant Recipients. RESULTS: The 133 responding programs (response rate = 66%) represented 77% of adult KTs and 79% of adult KT candidates in the United States. Respondents considered frailty to be a useful concept in evaluating candidacy (99%) and endorsed a need to develop a frailty measurement specific to KT (92%). Frailty measurement was more common during candidacy evaluation (69%) than during KT admission (28%). Of the 202 programs, 38% performed frailty assessments in all candidates while 23% performed assessments only for older candidates. There was heterogeneity in the frailty assessment method; 18 different tools were utilized to measure frailty. The most common tool was a timed walk test (19%); 67% reported performing >1 tool. Among programs that measure frailty, 53% reported being less likely to list frail patients for KT. CONCLUSIONS: Among US KT programs, frailty is recognized as a clinically relevant construct and is commonly measured at evaluation. However, there is considerable heterogeneity in the tools used to measure frailty. Efforts to identify optimal measurement of frailty using either an existing or a novel tool and subsequent standardization of its measurement and application across KT programs should be considered.
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Authors: Meera N Harhay; Maya K Rao; Kenneth J Woodside; Kirsten L Johansen; Krista L Lentine; Stefan G Tullius; Ronald F Parsons; Tarek Alhamad; Joseph Berger; XingXing S Cheng; Jaqueline Lappin; Raymond Lynch; Sandesh Parajuli; Jane C Tan; Dorry L Segev; Bruce Kaplan; Jon Kobashigawa; Darshana M Dadhania; Mara A McAdams-DeMarco Journal: Nephrol Dial Transplant Date: 2020-07-01 Impact factor: 5.992
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