A Study of Medical Frailty and Solid Organ Transplant

Donor Alliance Foundation recently awarded a grant to Kathleen Simpson, MD, for research on the “Longitudinal Assessment of Medical Frailty and Outcomes in Children Undergoing Solid Organ Transplant (SOT).”

At Children’s Hospital Colorado, Dr. Simpson concentrates her work on pediatric cardiomyopathy, heart failure and transplantation. While her focus is in cardiology, this research will look at improving the clinical assessment of disease severity in solid organ transplants, including liver and kidney in addition to heart.

The project design includes a novel collaborative effort across pediatric solid organ transplant programs at Children’s Colorado to better understand the impact of medical frailty on transplant outcomes in children. Frailty is a valuable and easily measurable predictive marker of health outcomes in adults, including those undergoing organ transplantation, but the usefulness of measuring serial frailty has not been well studied in children.

“If frailty proves to be a significant marker of disease and recovery,” says Dr. Simpson, “the outcomes of our study will help develop standardized pre-transplant frailty assessments in children and identify potential modifiable risk factors to target pre-transplant.”

Medical frailty describes the degree of “physiologic reserve” an individual has to respond to physiologically stressful events through assessment of patient strength, endurance, physical activity, and measurements of nutrition and growth. Using a standardized pediatric frailty assessment tool, modified from previously published experience in adults and children, the research team will strategically assess frailty before and after transplant in children listed for heart, liver and kidney transplantation. The team also plans to evaluate the presence of depression and anxiety to investigate whether these factors play a role in the degree of measured frailty.

Dr. Simpson says that the data and measurements collected for the frailty assessment are easily obtained outside of tertiary healthcare institutions at a relatively low cost without need for specialized equipment or training. Therefore, if shown to be useful, this standardized pediatric frailty assessment could be used beyond Children’s Colorado.

“In addition,” says Dr. Simpson, “after we establish a baseline prevalence of frailty and related outcomes in our population, we plan to establish a standardized protocol for assessment of frailty in transplant candidates at Children’s Colorado to develop targeted interventions in high-risk patients. Subsequently, frailty measurements can be easily performed serially in our transplant population to assess impact of therapeutic interventions over time.”

The information the team obtains could have far-reaching benefits for those involved in solid organ transplantation for the future. And Dr. Simpson’s hope is that once the benefits are established at Children’s Colorado, the information can be communicated to all pediatric solid organ transplant programs and have a broader impact on children and clinicians in the future.