Department of Surgery, Organ Transplant Center, University of Iowa Hospitals and Clinics, Iowa City, IA.
Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA.
Surgery. 2021 Mar;169(3):686-693. doi: 10.1016/j.surg.2020.07.016. Epub 2020 Aug 26.
Experience incorporating frailty and functional metrics in the transplant evaluation process is limited. We hypothesized that simple tests correlate with kidney transplant listing outcomes.
Frailty metrics, treadmill ability, pedometer data, troponin T, and brain natriuretic peptide were collected on 375 consecutive kidney transplant evaluations between July 2015 and December 2018. Patients initially denied were compared with those listed or deferred. Frailty metrics included handgrip, chair sit-stand, up-and-go, chair sit-reach, and questions related to exhaustion.
A total of 95 (25%) patients were initially denied. Those denied were older, diabetic, or had higher body mass indexes. Frailty metrics including chair sit-stand, up-and-go, chair sit-reach, grip strength, and exhaustion; biochemical markers troponin and brain natriuretic peptide; and pedometer and treadmill ability were all significantly associated with denial (P < .001). The best order three model combining parsimony and predictiveness included treadmill ability, exhaustion, and troponin. The most predictive pedometer model also included exhaustion and up-and-go. The best order three model excluding biochemical markers, pedometer, and treadmill results included up-and-go, exhaustion, and chair sit-reach.
Outcomes after on-site kidney transplant evaluation strongly correlated with the results of common clinical and functional frailty metrics.
在移植评估过程中纳入脆弱性和功能指标的经验有限。我们假设简单的测试与肾移植的列表结果相关。
2015 年 7 月至 2018 年 12 月期间，对 375 例连续肾移植评估进行了虚弱指标、跑步机能力、计步器数据、肌钙蛋白 T 和脑钠肽的检测。最初被拒绝的患者与被列入或推迟的患者进行比较。虚弱指标包括握力、椅子坐站、起身行走、椅子坐够伸手、与疲惫相关的问题。
共有 95 例（25%）患者最初被拒绝。被拒绝的患者年龄较大、患有糖尿病或体重指数较高。包括椅子坐站、起身行走、椅子坐够伸手、握力和疲惫等虚弱指标；生化标志物肌钙蛋白和脑钠肽；以及计步器和跑步机能力都与拒绝（P <.001）显著相关。结合简约性和预测性的最佳三模型包括跑步机能力、疲惫和肌钙蛋白。最具预测性的计步器模型还包括疲惫和起身行走。不包括生化标志物、计步器和跑步机结果的最佳三模型包括起身行走、疲惫和椅子坐够伸手。
现场肾移植评估的结果与常见的临床和功能虚弱指标的结果密切相关。
