Abstract
BACKGROUND: Reduced functional capacity increases the risk of adverse outcomes after kidney transplantation. The Duke Activity Status Index is a measurement of physical function, previously reported as being predictive of adverse outcomes after major non-cardiac surgery. This study assessed the ability of the Duke Activity Status Index to predict adverse outcomes for patients undergoing kidney transplantation. METHODS: Adult kidney transplant recipients with a Duke Activity Status Index calculated at time of listing for transplantation in Northern Ireland between 2019 and 2024 were analysed. Dichotomous outcomes (delayed graft function, unplanned critical care admission, 30-day hospital re-admission, 30-day severe postoperative complication, 30-day cardiovascular complication) were analysed using multivariate logistic regression. Post-transplant length of stay was assessed using multivariate linear regression. All-cause mortality and death-censored graft loss were evaluated using Cox proportional hazard regression models. RESULTS: Data was available for 408 kidney transplant recipients. Duke Activity Status Index was not predictive of delayed graft function (aOR 0.99 (95% CI 0.66-1.01) p = 0.359), unplanned critical care admission (aOR1.00 (95% CI 0.97-1.04), p = 0.866), length-of-stay post-transplant, 30-day hospital re-admission (aOR1.01 (95% CI 0.99-1.03), p = 0.457), 30-day severe postoperative complication (aOR 1.01 (95% CI 0.99-1.03) p = 0.489), 30-day cardiovascular complication (aOR 0.99 (95% CI 0.93-1.06), p = 0.850), all-cause mortality (aHR 1.00 (0.96-1.04), p = 0.89) or death-censored graft loss (aHR 0.97 (95% CI 0.93-1.01), p = 0.14). CONCLUSIONS: In this cohort, the Duke Activity Status Index was not an independent predictor of short or long-term adverse outcomes following kidney transplantation. These findings suggest that the Duke Activity Status Index may have limited utility in assessing functional capacity in waitlisted kidney transplant candidates. TRIAL REGISTRATION: Not applicable.