Author Affiliations: Department of Surgery, Johns Hopkins University School of Medicine (Drs Garonzik-Wang, Govindan, Hall, Berger, Montgomery, Desai, Dagher, Makary, Walston, and Segev, Messrs Grinnan, Liu, Ali, Jain, and James, and Mss Chakraborty, Ros, and Kucirka), and Department of Epidemiology, Johns Hopkins School of Public Health (Dr Segev), Baltimore, Maryland; Department of Surgery, Georgetown University, Washington, DC (Dr Hall); and Department of Surgery, University of Michigan Health System (Drs Sonnenday and Englesbe), and Department of Health Management and Policy, University of Michigan School of Public Health (Dr Sonnenday), Ann Arbor.
The ability to predict outcomes following a kidney transplant is limited by the complex physiologic decline of kidney failure, a latent factor that is difficult to capture using conventional comorbidity assessment. The frailty phenotype is a recently described inflammatory state of increased vulnerability to stressors resulting from decreased physiologic reserve and dysregulation of multiple physiologic systems. We hypothesized that frailty would be associated with delayed graft function, based on putative associations between inflammatory cytokines and graft dysfunction. We prospectively measured frailty in 183 kidney transplant recipients between December 2008 and April 2010. Independent associations between frailty and delayed graft function were analyzed using modified Poisson regression. Preoperative frailty was independently associated with a 1.94-fold increased risk for delayed graft function (95% CI, 1.13-3.36; P = .02). The assessment of frailty may provide further insights into the pathophysiology of allograft dysfunction and may improve our ability to preoperatively risk-stratify kidney transplant recipients.
Garonzik-Wang JM, Govindan P, Grinnan JW, Liu M, Ali HM, Chakraborty A, Jain V, Ros RL, James NT, Kucirka LM, Hall EC, Berger JC, Montgomery RA, Desai NM, Dagher NN, Sonnenday CJ, Englesbe MJ, Makary MA, Walston JD, Segev DL. Frailty and Delayed Graft Function in Kidney Transplant Recipients. Arch Surg. 2012;147(2):190-193. doi:10.1001/archsurg.2011.1229