Kidney transplantation in older people.Importance of frailty

The age structure on the waiting list for kidney transplantation (KTX) is increasingly moving towards older age groups. The KTX is considered the best treatment option for irreversible kidney failure but the risks increase with age, such as increased comorbidities. In this context chronological age is of secondary importance compared to biological age. This is largely determined by typical geriatric changes, often classified under the term frailty. Frailty is a condition with increased susceptibility to health stressors, which often occurs at a younger age in dialysis patients. Frailty is important for waiting list acceptance, postoperative outcome, quality of life and survival after KTX. To identify risks associated with frailty, geriatric screening and, if necessary, a multidimensional assessment are recommended. There are promising indications that problems identified in this way can be improved by specific measures and prehabilitation, thereby optimizing the outcome of KTX. In addition, the degree of frailty can decrease after KTX. There is still a need for studies on prehabilitation and to identify interventions to reduce frailty in this patient group.