TY - JOUR
T1 - Kidney transplant outcomes in recipients with cognitive impairment
T2 - A national registry and prospective cohort study
AU - Thomas, Alvin G.
AU - Ruck, Jessica M.
AU - Shaffer, Ashton A.
AU - Haugen, Christine E.
AU - Ying, Hao
AU - Warsame, Fatima
AU - Chu, Nadia
AU - Carlson, Michelle C.
AU - Gross, Alden L.
AU - Norman, Silas P.
AU - Segev, Dorry L.
AU - McAdams-DeMarco, Mara
N1 - Funding Information:
(PI: D.S.). Additionally, J.R. and D.S. are supported by a Doris Duke Charitable Foundation Clinical Research Mentorship grant. The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Mr. Thomas, Dr. Ruck, Ms. Shaffer, Dr. Haugen, Dr. Segev, and Dr. McAdams-DeMarco reported institutional grant support from the National Institutes of Health. Dr. Ruck and Dr. Segev also report institutional grant support from the Doris Duke Charitable Foundation. No other disclosures were reported. The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the U.S. Government. The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government.
Funding Information:
6Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI. A.G.T. and J.M.R. contributed equally to this article. Funding for this study was provided in part by the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK); National Heart, Lung, and Blood Institute (NHBLI); and the National Institute on Aging (NIA); grant numbers T32HL007055 (A.T.), K01AG043501 (PI: M.M.-D.), R01AG055781 (PI: M.M.-D.), R01DK114074 (PI: M.M.-D.), F30DK116658 (PI: A.S.), F32AG053025 (PI: C.H.), K01AG050699 (PI: A.G.), K24DK101828 (PI: D.S.), and R01DK096008
Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2019/7/1
Y1 - 2019/7/1
N2 - Background. Cognitive impairment is common in patients with end-stage renal disease and is associated with poor outcomes on dialysis. We hypothesized that cognitive impairment might be associated with an increased risk of all-cause graft loss (ACGL) in kidney transplant (KT) recipients. Methods. Using the Modified Mini-Mental State (3MS) examination, we measured global cognitive function at KT hospital admission in a prospective, 2-center cohort of 864 KT candidates (August 2009 to July 2016). We estimated the association between pre-KT cognitive impairment and ACGL using Cox regression, adjusting for recipient, donor, and transplant factors. Results. In living donor KT (LDKT) recipients, the prevalence was 3.3% for mild impairment (60 ≤ 3MS < 80) and 3.3% for severe impairment (3MS < 60). In deceased donor KT (DDKT) recipients, the prevalence was 9.8% for mild impairment and 2.6% for severe impairment. The LDKT recipients with cognitive impairment had substantially higher ACGL risk than unimpaired recipients (5-year ACGL: 45.5% vs 10.6%; P < 0.01; adjusted hazard ratio [aHR] any impairment, 5.40 (95% confidence interval [CI], 1.78-16.34; P < 0.01); aHR severe impairment, 5.57 (95% CI, 1.29-24.00; P = 0.02). Similarly, DDKT recipients with severe impairment had higher ACGL risk than recipients without severe impairment (5-year ACGL, 53.0% vs 24.2%; P = 0.04); aHR severe impairment, 2.92 (95% CI, 1.13-7.50; P = 0.03). Conclusions. Given the elevated risk of ACGL among KT recipients with cognitive impairment observed in this 2-center cohort, research efforts should explore the mechanisms of graft loss and mortality associated with cognitive impairment and identify potential interventions to improve posttransplant survival.
AB - Background. Cognitive impairment is common in patients with end-stage renal disease and is associated with poor outcomes on dialysis. We hypothesized that cognitive impairment might be associated with an increased risk of all-cause graft loss (ACGL) in kidney transplant (KT) recipients. Methods. Using the Modified Mini-Mental State (3MS) examination, we measured global cognitive function at KT hospital admission in a prospective, 2-center cohort of 864 KT candidates (August 2009 to July 2016). We estimated the association between pre-KT cognitive impairment and ACGL using Cox regression, adjusting for recipient, donor, and transplant factors. Results. In living donor KT (LDKT) recipients, the prevalence was 3.3% for mild impairment (60 ≤ 3MS < 80) and 3.3% for severe impairment (3MS < 60). In deceased donor KT (DDKT) recipients, the prevalence was 9.8% for mild impairment and 2.6% for severe impairment. The LDKT recipients with cognitive impairment had substantially higher ACGL risk than unimpaired recipients (5-year ACGL: 45.5% vs 10.6%; P < 0.01; adjusted hazard ratio [aHR] any impairment, 5.40 (95% confidence interval [CI], 1.78-16.34; P < 0.01); aHR severe impairment, 5.57 (95% CI, 1.29-24.00; P = 0.02). Similarly, DDKT recipients with severe impairment had higher ACGL risk than recipients without severe impairment (5-year ACGL, 53.0% vs 24.2%; P = 0.04); aHR severe impairment, 2.92 (95% CI, 1.13-7.50; P = 0.03). Conclusions. Given the elevated risk of ACGL among KT recipients with cognitive impairment observed in this 2-center cohort, research efforts should explore the mechanisms of graft loss and mortality associated with cognitive impairment and identify potential interventions to improve posttransplant survival.
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U2 - 10.1097/TP.0000000000002431
DO - 10.1097/TP.0000000000002431
M3 - Article
C2 - 30153224
AN - SCOPUS:85068830049
SN - 0041-1337
VL - 103
SP - 1504
EP - 1513
JO - Transplantation
JF - Transplantation
IS - 7
ER -