Change in frailty status in the 12 months following solid organ transplantation: a systematic review and meta-analysis

Objectives: To investigate if frailty status alters following solid organ transplantation (lung, liver, kidney and heart) without rehabilitation intervention.

Research design and methods: Studies published between 1 January 2000 and 30 May 2023 were searched across five databases. Studies measuring frailty, using a validated or established frailty measure, pre- and post-transplant were included. Narrative synthesis was used to describe the included studies according to the time post-transplant and according to solid organ group. Where data allowed a meta-analysis was conducted to compare frailty prevalence pre- and 6-12 months post-transplant across studies.

Results: Twelve studies were included in this review (6 kidney transplant, 2 liver transplant, 3 lung transplant and 1 heart transplant), with a total of 3065 transplant recipients with 62% being male. The mean age across studies was 51.35 years old. When narratively synthesised after an initial worsening of frailty immediately post-transplant, there appears to be a significant improvement in frailty by 3 months post-transplant that is sustained by 6 to 12 months following solid organ transplantation. Five studies were included in the meta-analysis which demonstrated an odds ratio = 0.27 (95% CI, 0.12, 0.59, P = .001, ${I}^2$ = 82%) for frailty prevalence post-solid organ transplantation (SOT) compared to frailty prevalence pre-SOT. When the single paper deemed to be of poor quality was removed the remaining four studies demonstrated a reduced odds ratio of being frail at 6-12 months post-transplant (OR 0.45 (95% CI, 0.32, 0.65, P = .001, ${I}^2$ = 13%).

Conclusions: Transplant may be associated with a reversal in frailty, although heterogeneity was demonstrated across studies.