Araji Hachem, Al-Ajlouni Yazan A, Nusier Jana, Sange Walid, El-Charabaty Elie, El-Sayegh Suzanne
Department of Internal Medicine, Northwell, New Hyde Park, New York, NY 11040, USA.
Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan.
Diseases. 2025 Jul 21;13(7):229. doi: 10.3390/diseases13070229.
The management of end-stage renal disease (ESRD) is undergoing a paradigm shift, with increasing emphasis on kidney transplantation as a preferred treatment modality for elderly patients (≥65 years), who constitute a substantial portion of new ESRD cases. Transplantation offers markedly superior survival and quality of life (QoL) advantages compared to dialysis for this demographic. Nevertheless, key determinants such as frailty, physical functionality, and cognitive function have emerged as critical predictors of post-transplant success. Despite their relevance, standardized methodologies for evaluating these parameters in transplantation candidacy remain absent. This systematic review examines the influence of frailty, physical functionality, and cognitive function on outcomes in elderly kidney transplant recipients.
Adhering to PRISMA guidelines, a rigorous literature search was conducted across PubMed, CINAHL, Embase, PsycINFO, and the Web of Science for studies published up to October 31, 2024. Relevant studies focused on elderly transplant candidates and examined correlations between frailty, physical functionality, or cognitive function and post-transplant outcomes. The Newcastle-Ottawa Scale was employed to evaluate studies quality.
Seven studies met the inclusion criteria. Five explored physical functionality, demonstrating that better pre-transplant physical performance predicts enhanced survival. Two studies addressed frailty, utilizing the Fried frailty phenotype, and linked frailty to elevated mortality and diminished QoL recovery. Notably, no studies explored cognitive function in elderly kidney transplant candidates or recipients and its association with post-transplant outcomes, exposing a salient gap in the literature. The included studies' varied methodologies, reliance on single time-point assessments, and exclusive focus on kidney transplant recipients restrict both comparability among studies and the generalizability of findings to the broader end-stage renal disease (ESRD) population.
These findings underscore the profound impact of physical functionality and frailty on transplant outcomes in the growing elderly kidney transplant population, illuminating the necessity for standardized assessment protocols and targeted pre-transplant interventions. The critical gap in cognitive function research underscores a vital direction for future investigation. This research received no external funding. This review is registered with PROSPERO under registration ID CRD42025645838.
终末期肾病（ESRD）的管理正在经历范式转变，越来越强调肾移植是老年患者（≥65岁）首选的治疗方式，这些老年患者在新增ESRD病例中占很大比例。与透析相比，肾移植为这一人群提供了明显更优的生存和生活质量（QoL）优势。然而，诸如衰弱、身体功能和认知功能等关键决定因素已成为移植后成功的关键预测指标。尽管它们具有相关性，但在评估移植候选资格时，仍缺乏评估这些参数的标准化方法。本系统评价探讨了衰弱、身体功能和认知功能对老年肾移植受者结局的影响。
遵循PRISMA指南，在PubMed、CINAHL、Embase、PsycINFO和Web of Science上对截至2024年10月31日发表的研究进行了严格的文献检索。相关研究聚焦于老年移植候选者，并研究了衰弱、身体功能或认知功能与移植后结局之间的相关性。采用纽卡斯尔-渥太华量表评估研究质量。
七项研究符合纳入标准。五项研究探讨了身体功能，表明移植前更好的身体表现预示着生存率提高。两项研究涉及衰弱，采用弗里德衰弱表型，并将衰弱与死亡率升高和生活质量恢复降低联系起来。值得注意的是，没有研究探讨老年肾移植候选者或受者的认知功能及其与移植后结局的关联，这揭示了文献中的一个显著空白。纳入研究的方法各不相同，依赖单一时间点评估，且仅关注肾移植受者，这限制了研究之间的可比性以及研究结果对更广泛的终末期肾病（ESRD）人群的可推广性。
这些发现强调了身体功能和衰弱对不断增加的老年肾移植人群移植结局的深远影响，阐明了标准化评估方案和有针对性的移植前干预措施的必要性。认知功能研究中的关键空白突出了未来研究的一个重要方向。本研究未获得外部资金。本综述已在PROSPERO注册，注册号为CRD42025645838。
