Frailty assessment in kidney transplantation: insights from a European survey

Background: Frailty has been identified as an important determinant of adverse transplant-related outcomes; however, its integration into routine kidney transplant practice remains limited. Methods: This was a web-based cross-sectional survey assessing current practice patterns and perceptions on frailty assessments among transplant physicians distributed by the DESCaRTES working group of the European Renal Association. The survey consisted of questions about frailty perceptions and practices both pre- and post-transplant. Results: A total of 134 responses (response rate 39.2%) were recorded. Although 98.5% recognized frailty as a risk factor for adverse outcomes, only 6.7% reported routinely performing a standardized frailty assessment in pre-transplant evaluations. Nearly 30% never evaluated frailty, and 24.6% did so only in selected high-risk patients, primarily based on age, comorbidities or prolonged dialysis duration. Physical function was recognized as the most important component of frailty assessments; however, no single assessment tool was consistently implemented. The main barriers to integrating frailty assessments into clinical practice were lack of trained staff, absence of standardized guidelines, and uncertainty about clinical usefulness. Post-transplant frailty assessments were rarely conducted routinely, despite 74.6% acknowledging their potential value. Conclusions: Despite widespread recognition of frailty as a significant determinant influencing transplant outcomes, its routine assessment in clinical practice remains limited across European centers. Variability in assessment tools, lack of guidelines and insufficient training resources contribute to this gap. Addressing these barriers through targeted education, validation of practical assessment tools, and consensus-driven protocols is essential to support the integration of frailty evaluation into both pre- and post-transplant care.