Cognitive impairment is common in end-stage renal disease patients and impedes adherence to complex treatment regimens. Given the complexities of post-transplant immunosuppression, we hypothesized that cognitive impairment at transplant is associated with an increased risk of all-cause graft loss (ACGL) among kidney transplant (KT) recipients.

METHODS: Using the Modified Mini-Mental State (3MS) examination, we measured global cognitive function in a prospective cohort of 864 KT candidates (8/2009-7/2016). We estimated the association between pre-KT cognitive impairment and ACGL using Cox regression adjusting for recipient, donor, and transplant factors.

RESULTS: The prevalences of impairment (3MS<80) and severe impairment (3MS<60) were 6.6% and 3.3%, respectively, among living donor KT (LDKT) recipients and 12.4% and 2.6%, respectively, among deceased donor KT (DDKT) recipients. We estimated 11.7% (8.5-14.9%) of US KT recipients had pre-transplant cognitive impairment. LDKT recipients with impairment had higher ACGL risk than recipients without impairment (5-year ACGL: 45.5% vs. 10.6%, p<0.01; aHR impairment: _1.785.40_16.34, p<0.01; aHR severe impairment: _1.295.57_24.00, p=0.02) (Figure 1). 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: _1.132.92_7.50, p=0.03) (Figure 2).

CONCLUSIONS: Given the prevalence of cognitive impairment and the associated elevated ACGL risk, pre-KT screening for impairment is warranted to identify higher-risk KT recipients.

CITATION INFORMATION: Thomas A., Ruck J., Shaffer A., Haugen C., Ying H., Warsame F., Chu N., Carlson M., Gross A., Norman S., Segev D., McAdams-DeMarco M. Cognitive Impairment and Graft Loss in Kidney Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress