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We hypothesized that having both depressive symptoms and frailty would be synergistic and worse than the independent effect of each. In a multicenter cohort study of 773 <jats:styled-content style=\"fixed-case\">KT<\/jats:styled-content> recipients, we measured the Fried frailty phenotype and the modified 18\u2010question Center for Epidemiologic Studies\u2010Depression Scale (<jats:styled-content style=\"fixed-case\">CES<\/jats:styled-content>\u2010D). Using adjusted Poisson regression and survival analysis, we tested whether depressive symptoms (<jats:styled-content style=\"fixed-case\">CES<\/jats:styled-content>\u2010D score\u00a0&gt;\u00a014) and frailty were associated with <jats:styled-content style=\"fixed-case\">KT<\/jats:styled-content> length of stay (<jats:styled-content style=\"fixed-case\">LOS<\/jats:styled-content>), death\u2010censored graft failure\u00a0(<jats:styled-content style=\"fixed-case\">DCGF<\/jats:styled-content>), and\u00a0mortality. At\u00a0<jats:styled-content style=\"fixed-case\">KT<\/jats:styled-content>\u00a0admission, 10.0% of patients exhibited depressive symptoms, 16.3% were frail, and 3.6% had both. Recipients with depressive symptoms were more likely to be frail\u00a0(<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>\u00a0=\u00a03.97, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 2.28\u20106.91, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001).\u00a0Recipients with both depressive symptoms and frailty had a 1.88 times (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 1.70\u20102.08, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001) longer <jats:styled-content style=\"fixed-case\">LOS<\/jats:styled-content>, 6.20\u2010fold (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>:1.67\u201022.95, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01)\u00a0increased risk of <jats:styled-content style=\"fixed-case\">DCGF<\/jats:styled-content>, and 2.62\u2010fold\u00a0(95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>:1.03\u20106.70, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.04)\u00a0increased risk of mortality, compared to those who were nonfrail and without depressive symptoms. There was only evidence of synergistic effect of frailty and depressive symptoms on length of stay (<jats:italic>P<\/jats:italic> for interaction\u00a0&lt;\u00a00.001). Interventions aimed at reducing pre\u2010<jats:styled-content style=\"fixed-case\">KT<\/jats:styled-content> depressive symptoms and frailty should be explored for their impact on post\u2010<jats:styled-content style=\"fixed-case\">KT<\/jats:styled-content> outcomes.<\/jats:p>","DOI":"10.1111\/ctr.13391","type":"journal-article","created":{"date-parts":[[2018,8,29]],"date-time":"2018-08-29T17:32:31Z","timestamp":1535563951000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":51,"title":["Depressive symptoms, frailty, and adverse outcomes among kidney transplant recipients"],"prefix":"10.1111","volume":"32","author":[{"given":"Jonathan M.","family":"Konel","sequence":"first","affiliation":[{"name":"Department of Surgery Johns Hopkins School of Medicine  Baltimore 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