Background: Delirium is the acute decline in cognitive function following a noxious insult like surgery. Previous studies in other surgical settings have identified frailty and cognitive dysfunction as risk factors for post-operative delirium and found that patients with delirium are at increased risk of mortality. The goal of this study was to explore this effect in kidney transplantation (KT).

Methods: We studied 730 KT recipients at Johns Hopkins Hospital (2009-2017) enrolled in a prospective cohort study. At admission for KT, frailty was measured using the Fried frailty phenotype and global cognitive function using the Modified Mini Mental Status Exam. We used a validated chart-abstraction algorithm to identify post-operative delirium throughout the KT hospitalization. Delirium risk factors were identified using logistic regression. The association between delirium and mortality and death censored graft loss were quantified using adjusted Cox proportional hazards models (adjusted for the factors in Table).

Results: There were 33 delirium cases (4.5%). Delirium was more common in recipients who were frail (9.2% vs. 3.6%; p=0.01), who had cognitive impairment (10.6% vs. 3.9%; p=0.02), and who were older (8.8% vs. 3.3%; p=0.01) at admission for KT. Frailty was independently associated with post-KT delirium. KT recipients with delirium were at a 3.60-fold (95% CI: 1.81-7.17, p<0.001) increased risk of post-KT mortality and a 3.02-fold (95% CI: 1.01-9.02, p=0.047) risk of death-censored graft loss after adjustment.

Conclusions: Among KT recipients, post-operative delirium is a strong risk factor for subsequent mortality and graft loss. Frail recipients are uniquely vulnerable to the post-operative complication. Transplant centers should be aware of the risks associated with post-KT delirium and implement interventions to reduce the risk of delirium.

CITATION INFORMATION: McAdams DeMarco M., Mountford A., Warsame F., Berkowitz R., Ying H., Haugen C., Brennan D., Segev D. Risk Factors and Sequelae of Post-KT Delirium Am J Transplant. 2017;17 (suppl 3).

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