Vulnerability and short clinical outcomes in patients on the deceased-donor kidney transplant waiting list.

A substantial proportion of patients on the deceased-donor kidney transplant waiting list demonstrated frailty characterized by obesity, sarcopenia, and malnutrition.

• Study included 134 patients on the DDKT waiting list starting December 2023
• Median age was 58 years, 68% were male
• 40% had obesity, 24% had sarcopenia, and nearly 50% exhibited malnutrition
• Median dialysis duration was 10 years

During 1 year of follow-up, 34 events (25%) occurred among wait-listed patients, comprising seven deaths and 27 hospitalizations.

• 25% event rate over 1 year
• Seven deaths occurred during the follow-up period
• 27 hospitalizations occurred secondary to infection, malignancy, or heart failure
• Death or hospitalization within 1 year was defined as the composite event endpoint

The fat mass index/fat-free mass index (FMI/FFMI) ratio was the strongest predictor of death or hospitalization within 1 year.

• Random forest and SHapley Additive Explanation (SHAP) analyses were used to identify predictors
• FMI/FFMI ratio was ranked as the strongest event predictor
• This was followed in predictive importance by low grip strength, reduced skeletal muscle mass index (SMI), low Survival Index, and low phase angle
• Age, comorbidity index, and several nutritional indices showed limited predictive contributions

Body composition was assessed using multifrequency bioelectrical impedance analysis and handgrip strength measurement.

• Multifrequency bioelectrical impedance analysis was used to assess body composition
• Nutritional indices calculated included Survival Index, Prognostic Nutritional Index, Geriatric Nutritional Risk Index, and Nutrition Risk Index for Japanese Hemodialysis Patients
• Handgrip strength was also measured as part of the assessment
• The study was a retrospective analysis

Objective body composition indicators, particularly FMI/FFMI, may aid in evaluating vulnerability and eligibility during registration and renewal for deceased-donor kidney transplantation.

• Waiting times for DDKT in Japan are prolonged and objective data on frailty among wait-listed patients are limited
• The authors suggest integrating these measures into standardized national criteria
• The authors propose this approach may improve equity and outcomes in DDKT candidate selection
• FMI/FFMI outperformed age, comorbidity index, and nutritional indices as a predictor