Introduction: Increased hospitalization rates and mortality have been reported in frailer patients with advanced chronic kidney disease, regardless of age. Our objective was to investigate whether frailty prior to transplantation in older kidney transplant recipients predicts outcomes, particularly CMV viremia, hospitalization and mortality.
Methods: We investigated outcomes of kidney transplant recipients (KTR) aged >60 years according to frailty scores prior to transplantation: Frail KTR scored ≥ 4 and non-frail KTR scored 1-3 using the clinical frailty scale. Outcomes were (i) CMV viraemia within the first 6-months, (ii)  rate of hospitalization within the first year post transplantation (iii) patient and graft survival.
Results: Between 2009-2021, 101 KTR over 60 years old with a documented frailty score prior to transplantation  were identified from our database who had 3 years of follow up. Patient’s characteristics are shown in Table 1.
Outcomes: There was higher rate of CMV infection in the frail group (55 %) compared with the non-frail group (34 %), p =0.03. Using univariate analysis , frail recipients demonstrated a more than two-fold increased risk of CMV viraemia (HR=1.97; 95% CI= 1.07-3.62) p=0.02 (Table 2). The overall percentage of KTR requiring readmission to hospital due to infections were higher, but not statistically different, in the frail group compared with the non-frail group in the first 12 months (47% vs 29 % respectively , p=0.07) , however, the mean number of infection-related admissions was higher in the frail vs non-frail group (2.11 vs 1.26 respectively, p=0.01 for the first year post transplantation. There was no difference in KTR survival between groups , however, the frail KTR experienced almost threefold the proportion of graft losses compared to the non-frail recipients.
Conclusion: Frailty scores prior to kidney transplantation predict CMV infection and infection related admissions in elderly (>60) KTR in this study. Therefore, using frailty scoring as a risk assessment tool prior to kidney transplantation could potentially help optimise frail KTR prior to  transplantation and stratify immunosuppression to reduce adverse infectious outcomes and re-admissions.