Pre-kidney transplant lower extremity impairment and transplant length of stay: a time-to-discharge analysis of a prospective cohort study

BackgroundFew objective tests can be performed at admission for kidney transplantation [KT] to discern risk of increased length of stay [LOS], which is important for patient counseling and is associated with increased costs and mortality. The short physical performance battery [SPPB] is an easily administered, potentially modifiable, 3-part test of lower extremity function. SPPB score is associated with longer hospital LOS in older adults, and may provide similar utility in KT recipients given that ESRD is a disease of accelerated aging. The aim of this study was to characterize the association between SPPB-derived lower extremity function and LOS.MethodsThe SPPB was administered at KT admission in a prospective cohort of 595 recipients (8/2009-6/2016). The independent association between SPPB impairment (score10) and LOS was tested with an adjusted conventional generalized gamma parametric survival model.ResultsImpaired recipients experienced longer LOS (median:10 vs.8days;P<0.001) with the greatest difference in percent discharged on day 10 (impaired:54.5%,unimpaired:73.3%). Discharge typically took 13% longer in the impaired group (relative time=1.13;95%CI:1.05,1.21,P=0.001). Discharge for impaired recipients compared to unimpaired was least likely at day 5 (hazard ratio=0.71; 95%CI:0.68,0.74,P<0.001). No differences in the SPPB impairment-LOS relationship were found by age (interaction P=0.74).ConclusionsPre-KT SPPB impairment was independently associated with longer LOS regardless of age, indicating that it is a useful, objective tool for pre-KT risk assessment in younger and older recipients that may help inform discharge planning.