Depressive symptoms, frailty, and adverse outcomes among kidney transplant recipients

Jonathan M. Konel, Fatima Warsame, Hao Ying, Christine E. Haugen, Alexandra Mountford, Nadia M. Chu, Deidra C. Crews, Niraj M. Desai, Jacqueline M. Garonzik-Wang, Jeremy D. Walston, Silas P. Norman, Dorry L. Segev, Mara A. McAdams-DeMarco

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Depressive symptoms and frailty are each independently associated with morbidity and mortality in kidney transplant (KT) recipients. We hypothesized that having both depressive symptoms and frailty would be synergistic and worse than the independent effect of each. In a multicenter cohort study of 773 KT recipients, we measured the Fried frailty phenotype and the modified 18-question Center for Epidemiologic Studies-Depression Scale (CES-D). Using adjusted Poisson regression and survival analysis, we tested whether depressive symptoms (CES-D score > 14) and frailty were associated with KT length of stay (LOS), death-censored graft failure (DCGF), and mortality. At KT admission, 10.0% of patients exhibited depressive symptoms, 16.3% were frail, and 3.6% had both. Recipients with depressive symptoms were more likely to be frail (aOR = 3.97, 95% CI: 2.28-6.91, P < 0.001). Recipients with both depressive symptoms and frailty had a 1.88 times (95% CI: 1.70-2.08, P < 0.001) longer LOS, 6.20-fold (95% CI:1.67-22.95, P < 0.01) increased risk of DCGF, and 2.62-fold (95% CI:1.03-6.70, P = 0.04) increased risk of mortality, compared to those who were nonfrail and without depressive symptoms. There was only evidence of synergistic effect of frailty and depressive symptoms on length of stay (P for interaction < 0.001). Interventions aimed at reducing pre-KT depressive symptoms and frailty should be explored for their impact on post-KT outcomes.

Original languageEnglish (US)
Article numbere13391
JournalClinical Transplantation
Issue number10
StatePublished - Oct 2018


  • depressive symptoms
  • frailty
  • graft loss
  • kidney transplant recipients
  • kidney transplantation
  • mortality

ASJC Scopus subject areas

  • Transplantation


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