Frailty Assessment as Part of Transplant Listing: Yes, No, or Maybe?


 Frailty, characterized by a decreased physiological reserve and an increased vulnerability to stressors, is common among kidney transplant (KT) candidates and recipients. In this review, we present and summarise the key arguments for and against the assessment of frailty as part of KT evaluation. The key arguments for including frailty were: 1) sheer prevalence and far-reaching consequences of frailty on KT, and 2) ability to conduct a more holistic and objective evaluation of candidates, removing the inaccuracy associated with ‘eye-ball’ assessments of transplant fitness. The key argument against were: 1) lack of agreement on the definition of frailty and which tools should be used in renal populations, 2) a lack of clarity on how, by whom, and how often frailty assessments should be performed, and 3) a poor understanding of how acute stressors affect frailty. However, it is the overwhelming opinion that the time has come for frailty assessments to be incorporated into KT listing. Although ongoing areas of uncertainty exist and further evidence development is needed, the well-established impact of frailty on clinical and experiential outcomes, the invaluable information obtained from frailty assessments, and the potential for intervention, outweighs these limitations. Proactive and early identification of frailty allows for individualised and improved risk assessment, communication, and optimisation of candidates.