The Role of Geriatric Syndromes in Kidney Transplant Decision-Making: A Domain-Based Analysis of Comprehensive...

As the population ages, kidney transplantation (KT) is increasingly considered for older adults with advanced chronic kidney disease (CKD). However, frailty, cognitive impairment, and malnutrition complicate transplant decision-making. A Comprehensive Geriatric Assessment (CGA) offers a multidimensional approach, but the relative contribution of individual CGA domains to transplant eligibility and receipt remains unclear.

We conducted a retrospective observational study of 164 older adults with advanced CKD seeking KT and underwent CGA by a geriatrician at an urban academic center from September 2021 to July 2024. Associations between CGA domains and KT listing and receipt were evaluated using logistic regression analyses, adjusting for age and other clinical covariates.

Of the 164 participants, 139 (84.8%) were listed, and 24 (17.3%) received KT among them. While higher levels of functional status, as measured by activities of daily living (ADL), were associated with KT listing, instrumental ADL and gait speed were significantly associated with transplantation. Even after adjusting for age, better cognitive function, as assessed through clinical evaluation and Montreal Cognitive Assessment (MoCA), was also positively associated with both outcomes. Age-adjusted nutritional status was independently associated with transplant listing eligibility.

Individual domains of CGA, particularly physical function, cognition, and nutrition, are independently associated with KT decision-making among older adults. Incorporating focused geriatric assessments into kidney transplant evaluation may improve risk stratification and reduce disparities in transplant access.