POST-TRANSPLANT FUNCTIONAL STATUS TRAJECTORY AMONG ADULT KIDNEY TRANSPLANT RECIPIENTS

Abstract

Frailty and disabilities are highly prevalent among kidney transplant (KT) recipients, but are not routinely measured in KT recipients. The Karnofsky Performance Scale (KPS) is a clinically perceived measure used to evaluate patient’s ability to manage daily activities, but little is known about its post-KT trajectories and its relationship to frailty and disability in KT recipients. We leveraged a cohort of 159,992 adult KT recipients from SRTR (1/2005-6/2018) and a cohort of 1,106 adult KT recipients from a prospective cohort study on aging and KT with recorded KPS (range 10%-100% integers). In each separate cohort, we used mixed effects models to assess differences in trajectories of KPS post-KT. In 159,992 KT recipients in SRTR, the mean unadjusted KPS score was 88.34% (95%CI: 88.28%, 88.40%) and declined at a rate of -0.59%/year (95%CI: -0.61%, -0.57%) post-KT, such that by 2-years post-KT the average was 87.00% (95%CI: 86.94%, 87.05%). Age at KT was associated with steeper decline in KPS (p0.05). KPS is a measure of functional status distinct from frailty, ADL, IADL, and SPPB at KT admission that declines with older age post-KT. Older KT recipients should be monitored closely for declines in physical function, and potentially undergo prehabilitation to improve functional status post-KT.