Kidney Transplantation in Older People: understanding the patient’s experience

Transplantation for older patients remains a challenge. With increasing numbers of older patients developing
end-stage kidney disease (ESKD), there is an expectation from many that transplantation should be
offered. Frailty and cognitive impairment are common in this patient group but often under-recognised. Little is
known about the impact of frailty and its components, particularly cognitive impairment, on transplant
outcomes, patient experiences, quality of life and adherence to complex immunosuppression drug regimes.
Central to the proposed mixed methods research is a prospective observational study enrolling patients >60
years old from the transplant wait-list who may already be frail, or develop frailty during the study duration.
Quality of life will be assessed using questionnaires at study visits (0, 12, 24 months on wait-list; 3, 12 months
post-transplant) alongside recording clinical outcomes. Adherence to immunosuppression will be assessed at
post-transplant visits. Impact of age and frailty induced inflammatory state and immunosenescence will be
assessed by measuring various biomarkers at entry to the study and correlating them with subsequent patient
and transplant outcomes.
Qualitative methods will run concurrently to explore the older person with frailty’s experience, management and
expectations of transplantation longitudinally. Participants will be recruited from the main study by convenience
sampling whilst on the wait-list. Semi-structured interviews will be undertaken (on waitlist and one year later or 3
and 12 months post transplantation). Novel to this study, diary method and photography (for those unable to
complete a diary) will be used to capture “in the moment” experiences ensuring that those with a range of
communication needs are able to participate. These qualitative methods will assist in understanding participant’s
changing perspectives and experiences adjusting to life after transplantation and will be critical to supporting and
improving services for older people undergoing this increasingly common treatment pathway.