Background: HRQOL reflects a patient's disease burden, treatment effectiveness, and health status and is summarized by physical, mental, and kidney disease-specific scales among ESRD patients. While on average HRQOL improves post-KT, the degree of change depends on the ability of the patient to withstand the stressor of dialysis versus the ability to tolerate the intense physiologic changes of KT. Frail KT recipients may be extra vulnerable to either of these stressors, thus affecting change in HRQOL after KT. Methods: We ascertained frailty as well as physical, mental, and kidney disease-specific HRQOL in a multicenter prospective cohort of 443 KT recipients (5/2014-5/2017) using KDQOL. We quantified the short-term (3 month) rate of post-KT HRQOL change by frailty status using adjusted mixed-effects linear regression models. Results: Mean HRQOL scores at KT were 43.3(SD=9.6) for physical, 52.8(SD=8.9) for mental, and 72.6(SD=12.8) for kidney disease-specific HRQOL; frail recipients had worse physical (p
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