Implications of Frailty for Peritransplant Outcomes in Kidney Transplant Recipients
Implications of Frailty for Peritransplant Outcomes in Kidney Transplant Recipients
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DOI：
10.1007/s40472-019-0227-z
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发表时间：
2019-03-15
影响因子：
2.1
通讯作者：
Tan, Jane C.
中科院分区：
文献类型：
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作者：
Cheng, Xingxing S.;Lentine, Krista L.;Tan, Jane C.
回顾的目的过去几十年的研究指出了脆弱或缺乏生理储备在慢性疾病的自然史和改变潜在干预影响中的重要性。终末期肾病（ESKD）和肾移植干预也不例外。我们回顾了最近关于虚弱和肾移植结果之间关联的流行病学和基于队列的证据，并提供了一个问题框架，以接近未来的研究努力和临床实践。肾移植候选者的虚弱可以通过多种方式测量，包括描述性表型、描述评分、功能测试和替代测量。无论采用何种衡量标准，与没有虚弱相比，虚弱的存在与移植前和移植后较差的预后密切相关。然而，一些虚弱的ESKD患者可以从移植中获益，而不是长期透析。目前缺乏以证据为基础的方法来识别体弱者ESKD患者，这些患者可以从移植而不是透析中获益，并且移植后预后可接受。在移植前（预康复）和移植后（康复）改善虚弱和身体功能的介入性试验也缺乏。虚弱越来越被认为与移植周围的结果高度相关，但需要做更多的工作来(1)根据移植前和移植后虚弱患者的独特需求量身定制管理；(2)确定体弱多病患者的表型，这些患者预计将从移植中受益，而不是透析；(3)开发干预措施来逆转移植前后的虚弱。
Purpose of Review Research over the past few decades points to the importance of frailty, or the lack of physiologic reserve, in the natural history of chronic diseases and in modifying the impact of potential interventions. End-stage kidney disease (ESKD) and the intervention of kidney transplantation are no exception. We review the recent epidemiologic and cohort-based evidence on the association between frailty and kidney transplant outcomes and provide a framework of questions with which to approach future research endeavors and clinical practice. Recent Findings Frailty in kidney transplant candidates can be measured in numerous ways, including descriptive phenotype, description scores, functional testing, and surrogate measures. Regardless of the metric, the presence of frailty is strongly associated with inferior pre- and posttransplant outcomes compared with the absence of frailty. However, some frail patients with ESKD can benefit from transplant over chronic dialysis. Evidence-based approaches for identifying frail ESKD patients who can benefit from transplant over dialysis, with acceptable posttransplant outcomes, are lacking. Interventional trials to improve frailty and physical function before transplant (prehabilitation) and after transplant (rehabilitation) are also lacking. Frailty is increasingly recognized as highly relevant to peritransplant outcomes, but more work is needed to (1) tailor management to the unique needs of frail patients, both pre- and posttransplant; (2) define phenotypes of frail patients who are expected to benefit from transplant over dialysis; and (3) develop interventions to reverse frailty, both pre- and posttransplant.