Background: Older recipients have a high burden of dementia after kidney transplantation (KT). Factors contributing to post-KT dementia may include long-standing kidney disease, comorbid vascular disease and/or neurotoxic immunosuppressant agents. It is unclear whether specific immunosuppressant regimens increase the risk of dementia.

Methods: We studied 36,612 older (aged≥55) KT recipients (1/1/99-12/31/11) linked to Medicare claims through USRDS with a link to SRTR data. We estimated the post-KT dementia (using validated ICD-9 claims algorithm) risk by IS regimen using an adjusted (for recipient, transplant, and donor factors) Cox proportional hazards model. The IS regimens were categorized as: 1) ATG induction + Tac + MPA (including mycophenolate mofetil and mycophenolate sodium)/AZA + Pred; 2) IL2rAb induction, + Tac + MPA/AZA + Pred +; 3) No induction, + Tac + MPA/AZA + Pred; 4) CNI free regimens; and 5) antimetabolite avoidance regimens. IS regimens were considered time-varying and updated at 6 and 12 months post-KT then yearly, thereafter; the comparison groups were older KT recipients not exposed to that specific IS regimen.

Results: There were 2,216 incident diagnoses of dementia during an average of 3.4 years of follow-up. At discharge, the most common IS regimen was ATG induction + Tac + MPA/AZA + Pred,and this regimen was not associated with dementia (Table). However, replacing ATG induction with IL2rAb induction in this regimen was associated with a decreased risk of dementia (HR=0.85; 95% CI: 0.74-0.97; p=0.016). Antimetabolite avoidance regimens were associated with an increased risk of dementia (HR=1.27; 95% CI: 1.15-1.41; p<0.001).

Conclusions: Older KT recipients have a high risk of post-KT dementia. However, the risk of dementia varies by not only IS regimen but also by induction type. There is the need for greater awareness of the risk for dementia and optimizing IS to prevent dementia in this population.

CITATION INFORMATION: McAdams DeMarco M., Haugen C., Bae S., Lentine K., Segev D. Immunosuppression and the Risk of Dementia among Older Kidney Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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