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Aim: To present the rationale, design and methodology of the GERAS project, which examines whether assessment of frailty and mild cognitive impairment could enhance risk prediction for biomedical, psychosocial outcomes and foster efficient resource allocation in kidney transplantation. Background: For the burgeoning cohort of older patients considered for kidney transplantation, evidence gaps regarding frailty and mild cognitive impairment limit clinical decision-making and medical management. As known risk factors for ‘hard’ clinical outcomes in chronic illness, both require further study in transplantation. Integrating these and other bio-psychosocial factors into a comprehensive pre-transplant patient assessment will provide insights regarding economic implications and may improve risk prediction. Design: A nation-wide multi-centre prospective cohort study nested in the Swiss Transplant Cohort Study. Methods: Our nationally representative convenience sample includes 250 adult kidney transplant recipients. Data sources include the Swiss Transplant Cohort Study and primary data collected at time of transplantation, 6 months, 1 and 2 years post-transplant via established measures (the Montreal Cognitive Assessment, Psychosocial Questionnaire, Fried Frailty Instrument and a blood analysis), investigator-developed instruments and datasets compiled by hospitals’ management control units, sickness funds, the Swiss Federal Statistical Office and the European Renal Association. Descriptive, competing risk survival and mixed effects analyses will be performed. Research Ethics Committee approval was obtained in January 2016. Discussion: This pioneering project jointly examines frailty and mild cognitive impairment from bio-psychosocial and health economic perspectives. Results may significantly inform risk prediction, care tailoring and resource optimization to improve health outcomes in the ageing kidney transplant cohort.

© 2017 Elsevier Inc. Background There is growing consensus that frailty, a state of vulnerability and a decline in functioning across multiple physiological body systems, is a valuable criterion to guide clinicians’ risk prediction for poor outcomes in adult transplant candidates. In its 2016 listing criteria for heart transplantation the International Society for Heart Lung Transplantation recommends frailty assessment. We aimed to summarize the usefulness of frailty assessment in heart transplant candidates or recipients reported throughout the literature. Methods We performed a systematic literature search in PubMed to identify papers reporting on frailty in transplantation, chronic heart failure, and ventricualr assist device implantation published over the last 10 years in English. Additionally, a hand search was conducted, including manually searching the reference lists and a citation search of relevant papers. Results Eleven primary research articles were included in this systematic review. Frailty is a risk factor for morbidity, hospitalization, and mortality in patients with advanced heart failure and individuals being considered for ventricualr assist device implantation. Of the patients being considered for transplantation, 33% are frail. The Frailty Phenotype by Fried is a particularly useful tool to quickly identify higher risk patients for adverse outcomes. Conclusion A lack of standardization and limited evidence on frailty in transplantation limit its use as a definitive listing criterion. Future research efforts should focus on systematic integration of frailty measures in transplant practice.

© 2017 Elsevier Inc. Background There is growing consensus that frailty, a state of vulnerability and a decline in functioning across multiple physiological body systems, is a valuable criterion to guide clinicians’ risk prediction for poor outcomes in adult transplant candidates. In its 2016 listing criteria for heart transplantation the International Society for Heart Lung Transplantation recommends frailty assessment. We aimed to summarize the usefulness of frailty assessment in heart transplant candidates or recipients reported throughout the literature. Methods We performed a systematic literature search in PubMed to identify papers reporting on frailty in transplantation, chronic heart failure, and ventricualr assist device implantation published over the last 10 years in English. Additionally, a hand search was conducted, including manually searching the reference lists and a citation search of relevant papers. Results Eleven primary research articles were included in this systematic review. Frailty is a risk factor for morbidity, hospitalization, and mortality in patients with advanced heart failure and individuals being considered for ventricualr assist device implantation. Of the patients being considered for transplantation, 33% are frail. The Frailty Phenotype by Fried is a particularly useful tool to quickly identify higher risk patients for adverse outcomes. Conclusion A lack of standardization and limited evidence on frailty in transplantation limit its use as a definitive listing criterion. Future research efforts should focus on systematic integration of frailty measures in transplant practice.

Effects of daily injections of pituitary-derived bovine somatotropin (bST) for 6 wk were evaluated in 10 growing heifers and compared to 9 placebo-treated control animals. Bovine somatotropin was injected at 50 micrograms/kg BW each day. Body weight and growth, plasma concentrations of insulin-like growth factor I (IGF-I) and somatotropin (ST) were assessed. To measure plasma concentrations of IGF-I, we validated a RIA in which bovine plasma samples were extracted with acid-ethanol, a method that resulted in greater than 90% recovery of IGF-I. Average daily gain was similar during the first 4 wk of the experiment in both control and bST-treated groups; however, at the end of the experimental period (wk 4 and 6) ADG was greater (P less than .05) in bST-treated heifers (1.24 +/- .21 kg/d vs .75 +/- .25 kg/d). Plasma IGF-I from wk 2 to wk 6 were increased in bST-treated animals (452 +/- 97 ng/ml at wk 2; 683 +/- 106 ng/ml at wk 6) compared with controls (293 +/- 62 ng/ml at wk 2 (P less than .01) and 293 +/- 115 ng/ml at wk 6 (P less than .001). Moreover, ADG over the 6-wk experimental period was correlated with mean IGF-I concentrations determined over the same period (r = .55; P less than .01). As expected, mean plasma ST concentrations were increased in bST-injected animals from wk 1 to 6. Gel chromatographic profiles of bovine plasma exhibit a 150,000 molecular weight ST-dependent binding protein-IGF-I complex and a 30,000 molecular weight non-ST-dependent complex. This study validates a method for measuring IGF-I in cattle, and shows a positive relationship among IGF-I and ADG after ST treatment. No correlation, however, was found between plasma ST and growth performance.