title: Changes in Frailty After Kidney Transplantation.
abstract: OBJECTIVE
  To understand the natural history of frailty after an aggressive surgical intervention, kidney transplantation (KT).
  
  
  METHODS
  Prospective cohort study (December 2008-March 2014).
  
  
  METHODS
  Baltimore, Maryland.
  
  
  METHODS
  Kidney transplantation recipients (N = 349).
  
  
  METHODS
  The Fried frailty score was measured at the time of KT and during routine clinical follow-up. Using a Cox proportional hazards model, factors associated with improvements in frailty score after KT were identified. Using a longitudinal analysis, predictors of frailty score changes after KT were identified using a multilevel mixed-effects Poisson model.
  
  
  RESULTS
  At KT, 19.8% of recipients were frail; 1 month after KT, 33.3% were frail; at 2 months, 27.7% were frail; and at 3 months, 17.2% were frail. On average, frailty scores had worsened by 1 month (mean change 0.4, P < .001), returned to baseline by 2 months (mean change 0.2, P = .07), and improved by 3 months (mean change -0.3, P = .04) after KT. The only recipient or transplant factor associated with improvement in frailty score after KT was pre-KT frailty (hazard ratio = 2.55, 95% confidence interval (CI) = 1.71-3.82, P < .001). Pre-KT frailty status (relative risk (RR) = 1.49, 95% CI = 1.29-1.72, P < .001), recipient diabetes mellitus (RR = 1.26, 95% CI = 1.08-1.46, P = .003), and delayed graft function (RR = 1.22, 95% CI = 1.04-1.43, P = .02) were independently associated with long-term changes in frailty score.
  
  
  CONCLUSIONS
  After KT, in adult recipients of all ages, frailty initially worsens but then improves by 3 months. Although KT recipients who were frail at KT had higher frailty scores over the long term, they were most likely to show improvements in their physiological reserve after KT, supporting the transplantation in these individuals and suggesting that pretransplant frailty is not an irreversible state of low physiological reserve.
authors.affiliation: Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland.|Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Mara A
authors.initials: MA
authors.lastname: McAdams-DeMarco
authors.affiliation: Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Kyra
authors.initials: K
authors.lastname: Isaacs
authors.affiliation: Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Louisa
authors.initials: L
authors.lastname: Darko
authors.affiliation: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Megan L
authors.initials: ML
authors.lastname: Salter
authors.affiliation: Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Natasha
authors.initials: N
authors.lastname: Gupta
authors.affiliation: Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: King
authors.affiliation: Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Walston
authors.affiliation: Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland.|Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000328:Adult; D000368:Aged; D051799:Delayed Graft Function / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000601:surgery; D007677:Kidney Function Tests / Q000706:statistics & numerical data; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D011184:Postoperative Period; D057234:Preoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate
keywords: frailty; kidney transplantation; physiological reserve