Department of Medicine, Division of Nephrology, Drexel University College of Medicine, Philadelphia, PA, USA.
Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA.
Nephrol Dial Transplant. 2020 Jul 1;35(7):1099-1112. doi: 10.1093/ndt/gfaa016.
The construct of frailty was first developed in gerontology to help identify older adults with increased vulnerability when confronted with a health stressor. This article is a review of studies in which frailty has been applied to pre- and post-kidney transplantation (KT) populations. Although KT is the optimal treatment for end-stage kidney disease (ESKD), KT candidates often must overcome numerous health challenges associated with ESKD before receiving KT. After KT, the impacts of surgery and immunosuppression represent additional health stressors that disproportionately impact individuals with frailty. Frailty metrics could improve the ability to identify KT candidates and recipients at risk for adverse health outcomes and those who could potentially benefit from interventions to improve their frail status. The Physical Frailty Phenotype (PFP) is the most commonly used frailty metric in ESKD research, and KT recipients who are frail at KT (~20% of recipients) are twice as likely to die as nonfrail recipients. In addition to the PFP, many other metrics are currently used to assess pre- and post-KT vulnerability in research and clinical practice, underscoring the need for a disease-specific frailty metric that can be used to monitor KT candidates and recipients. Although frailty is an independent risk factor for post-transplant adverse outcomes, it is not factored into the current transplant program risk-adjustment equations. Future studies are needed to explore pre- and post-KT interventions to improve or prevent frailty.
虚弱的概念最初是在老年医学中提出的，旨在帮助识别出在面临健康压力时易受伤害的老年人。本文综述了将虚弱应用于肾移植（KT）前和移植后的研究。尽管 KT 是终末期肾病（ESKD）的最佳治疗方法，但 KT 候选者在接受 KT 之前通常必须克服与 ESKD 相关的许多健康挑战。接受 KT 后，手术和免疫抑制的影响是另外的健康压力源，这对虚弱的个体产生不成比例的影响。虚弱指标可以提高识别 KT 候选者和面临不良健康结果风险以及可能受益于改善其虚弱状态的干预措施的能力。身体虚弱表型（PFP）是 ESKD 研究中最常用的虚弱指标，在 KT 时虚弱的 KT 受者（约 20%的受者）死亡的可能性是不虚弱受者的两倍。除了 PFP 之外，目前在研究和临床实践中还使用许多其他指标来评估 KT 前和 KT 后的脆弱性，这突出表明需要一种特定于疾病的虚弱指标，用于监测 KT 候选者和受者。尽管虚弱是移植后不良结局的独立危险因素，但它并未纳入当前的移植项目风险调整方程。需要进一步研究探索 KT 前后的干预措施，以改善或预防虚弱。
