Background: Cognitive impairment is common in end stage renal disease and affects health outcomes. Cognitive impairment after solid organ transplants affects medication adherence and graft outcomes. Whether pre-transplant cognition influences transplant eligibility remains unknown.

Method: All consecutive patients referred to our center for kidney transplantation were screened for cognitive impairment using the Montreal Cognitive Assessment (MoCA). MoCA is a validated screening tool for use in outpatient clinics to screen for cognitive impairment. A score of < 26 suggests cognitive impairment. The transplant team and the transplant committee were blinded to MoCA scores while discussing listing of patients for transplant. Fisher's exact test was used for statistical analysis.

Results: 636 patients (56% men, 70% white) completed MoCA. The majority of patients (62%) had attended some college, 44% had diabetes, 41% had coronary artery disease. 54% of the patients had cognitive impairment defined by MoCA score < 26. Patients with cognitive impairment were older and more commonly men. There was no significant difference in the prevalence of diabetes or time on dialysis in patients with and without cognitive impairment. Patients with cognitive impairment were more often declared ineligible for transplantation or removed from the waitlist (46% vs 33%, p= 0.001), and were less often transplanted or listed 'active' on the kidney transplant waitlist (31% vs 45%; p = 0.0003). There was no difference in the number of patients in the pre-transplant evaluation phase, where their eligibility for transplantation has not been determined.

Conclusion: Cognitive impairment appears to influence transplant eligibility of patients with end stage renal disease.

CITATION INFORMATION: Gupta A., Klein J., Mahnken J., Montgomery R., Ilahe A., Budhiraja P., Thomas T., Schmitt T., Burns J., Cibrik D. Cognitive Impairment Influences Transplant Eligibility Am J Transplant. 2017;17 (suppl 3).

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