Quint Evelien E, Zogaj Donika, Banning Louise B D, Benjamens Stan, Annema Coby, Bakker Stephan J L, Nieuwenhuijs-Moeke Gertrude J, Segev Dorry L, McAdams-DeMarco Mara A, Pol Robert A
Division of Transplantation Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Division of Nursing Science, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Transplant Direct. 2021 May 18;7(6):e701. doi: 10.1097/TXD.0000000000001156. eCollection 2021 Jun.
Frailty is a multidimensional condition and is the result of the body's age-associated decline in physical, cognitive, physiological, and immune reserves. The aim of this systematic review is to assess the quality of evidence of the included studies, determine the prevalence of frailty among kidney transplant candidates, and evaluate the relationship between frailty and associated patient characteristics and outcomes after kidney transplantation.
A systematic search was performed for relevant literature on frailty and kidney transplantation. This was followed by a meta-analysis for patient characteristics and outcomes reported by a minimum of 2 studies including mean age, gender, mean body mass index, type of kidney transplantation, dialysis, previous kidney transplantation, comorbidities, hypertension, race, preemptive kidney transplantation, delayed graft function, and length of stay.
A total of 18 studies were included in the systematic review and 14 of those studies were suitable for meta-analysis. The overall pooled prevalence of frailty before transplantation was estimated at 17.1% (95% confidence interval [CI], 15.4-18.7). Frailty was significantly associated with higher age (mean difference, 3.6; 95% CI, 1.4-5.9), lower rate of preemptive transplantation (relative risk, 0.60; 95% CI, 0.4-0.9), longer duration of delayed graft function (relative risk, 1.80; 95% CI, 1.1-3.0), and length of stay longer than 2 wk (odds ratio, 1.64; 95% CI, 1.2-2.3).
One in 6 kidney transplant recipients is frail before transplantation. The presence of frailty is associated with lower rates of preemptive transplantation, older recipient age, higher rates of delayed graft function, and longer length of stay. Future research is required to explore the association of frailty with other adverse outcomes after kidney transplantation and the effects of intervention programs to improve the different frailty domains.
衰弱是一种多维度状况，是身体与年龄相关的身体、认知、生理和免疫储备下降的结果。本系统评价的目的是评估纳入研究的证据质量，确定肾移植候选者中衰弱的患病率，并评估衰弱与相关患者特征及肾移植后结局之间的关系。
对有关衰弱和肾移植的相关文献进行系统检索。随后对至少2项研究所报告的患者特征和结局进行荟萃分析，包括平均年龄、性别、平均体重指数、肾移植类型、透析、既往肾移植、合并症、高血压、种族、择期肾移植、移植肾功能延迟、住院时间。
系统评价共纳入18项研究，其中14项研究适合进行荟萃分析。移植前衰弱的总体合并患病率估计为17.1%（95%置信区间[CI]，15.4 - 18.7）。衰弱与较高年龄显著相关（平均差异，3.6；95%CI，1.4 - 5.9）、择期移植率较低（相对风险，0.60；95%CI，0.4 - 0.9）、移植肾功能延迟持续时间较长（相对风险，1.80；95%CI，1.1 - 3.0）以及住院时间超过2周（优势比，1.64；95%CI，1.2 - 2.3）。
六分之一的肾移植受者在移植前衰弱。衰弱的存在与择期移植率较低
