Parajuli Sandesh, Astor Brad C, Lorden Heather M, O'Toole Kristan A, Wallschlaeger Rebecca E, Breyer Isabel C, Dodin Ban, Aziz Fahad, Garonzik-Wang Jacqueline, Mandelbrot Didier A
Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Clin Transplant. 2022 Dec;36(12):e14827. doi: 10.1111/ctr.14827. Epub 2022 Oct 13.
Frailty is commonly assessed during kidney transplant recipient (KTR) evaluation. However, individual frailty components may have varying impact on post-transplant outcomes. In this single-center study of 825 KTRs, we determined the association between the individual components of a modified Fried frailty score and delayed graft function (DGF), early hospital readmission (EHR), cardiovascular (CV) events, acute rejection (AR), death censored graft failure (DCGF), and death. Sum frailty ≥3 was significantly associated with EHR (aOR = 3.62; 95% CI: 1.21-10.80). Among individual components, only grip strength was significantly associated with EHR (aOR = 1.54; 95% CI: 1.03-2.31). The addition of grip strength to a model with the other four components resulted in Net Reclassification Improvement (NRI) of 20.51% (p = .01). Similarly, only grip strength was significantly associated with CV events (aOR = 1.79; 95% CI: 1.12-2.86). The addition of grip strength to a model with the other four components resulted in NRI of 27.37% (p = .006). No other frailty components were associated with the outcomes of interest. Based on our findings, handgrip strength may be an important tool while assessing frailty, mainly predicting early readmission and cardiovascular events post-transplant.
在肾移植受者（KTR）评估过程中，通常会对虚弱程度进行评估。然而，个体虚弱成分对移植后结局可能有不同影响。在这项针对825名KTR的单中心研究中，我们确定了改良的弗里德虚弱评分的各个成分与移植肾功能延迟恢复（DGF）、早期医院再入院（EHR）、心血管（CV）事件、急性排斥反应（AR）、死亡审查的移植失败（DCGF）和死亡之间的关联。总虚弱评分≥3与EHR显著相关（调整后比值比[aOR]=3.62；95%置信区间[CI]：1.21-10.80）。在各个成分中，只有握力与EHR显著相关（aOR=1.54；95%CI：1.03-2.31）。将握力添加到包含其他四个成分的模型中，净重新分类改善（NRI）为20.51%（p=0.01）。同样，只有握力与CV事件显著相关（aOR=1.79；95%CI：1.12-2.86）。将握力添加到包含其他四个成分的模型中，NRI为27.37%（p=0.006）。没有其他虚弱成分与感兴趣的结局相关。基于我们的研究结果，握力可能是评估虚弱程度时的一个重要工具，主要用于预测移植后的早期再入院和心血管事件。
