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Post-Kidney Transplant Dementia Risk by Modifiable Risk Factors and CNIs Among Older Recipients

Y. Chen1, J. Ahn1, N. Chu1, S. Bae1, M. A. Schnitzler2, G. Hess3, K. Lentine4, D. Segev5, M. McAdams-DeMarco1

1Johns Hopkins School of Medicine, Baltimore, MD, 2Surgery, Saint Louis University, O Fallon, IL, 3Drexel University School of Medicine, Philadelphia, PA, 4Saint Louis University, St. Louis, MO, 5Johns Hopkins University, Baltimore, MD

Meeting: 2022 American Transplant Congress

Abstract number: 1386

Keywords: Calcineurin, Elderly patients, Kidney transplantation, Risk factors

Topic: Clinical Science » Kidney » 37 - Kidney Immunosuppression: Induction Therapy

Session Information

Session Name: Kidney Immunosuppression: Induction Therapy

Session Type: Poster Abstract

Date: Monday, June 6, 2022

Session Time: 7:00pm-8:00pm

 Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

*Purpose: Up to 17% of older recipients develop dementia after kidney transplant (KT). While there are known modifiable risk factors for dementia among community-dwelling older adults, it is unclear whether Calcineurin Inhibitors (CNIs) are a KT-specific modifiable risk factor.

*Methods: We identified 28,901 KT recipients (aged 55 and above) using data from the United States Renal Data System. We estimated the risk of post-KT dementia associated with CNIs and modifiable risk factors (education, obesity, history of diabetes, hypertension and depression) using competing risk analysis accounting for transplant center-level variation. Models incorporated inverse probability weighting to adjust for confounders.

*Results: The 10-year cumulative incidence of post-KT dementia was 12.0% for recipients on a CNIs-free regimen and 16.9% for others treated with CNIs. Tacrolimus (sHR, 1.46; 95% CI, 1.10 to 1.94) and cyclosporin (sHR, 1.54; 95% CI, 1.08 to 2.14) regimens were equally associated with an increased risk of incident dementia (pinteraction=0.22). The magnitude of the dementia risks associated with CNIs were similar to what we observed for hearing loss (sHR, 1.36; 95% CI, 1.07 to 1.73), history of diabetes (sHR, 1.30; 95% CI, 1.11 to 1.51) and no education (sHR, 1.47; 95% CI, 1.00 to 2.15) but lower than what we observed for pre-KT depression (sHR, 2.45; 95% CI, 2.13 to 2.83); no other modifiable risks factors were identified (Table). The association of CNIs with post-KT dementia differed significantly by history of diabetes (pinteraction=0.03); stronger association was seen among recipients with diabetes (sHR, 2.10, 95% CI, 1.35 to 3.26) than those without (sHR, 1.13, 95% CI, 0.75 to 1.64).

*Conclusions: CNIs were associated with higher post-KT dementia risk regardless of agent; these risks were comparable or stronger than what we observed for other traditional modifiable risk factors. Personalized IS regimens, particularly among recipients with diabetes may be needed to prevent post-KT dementia.

Post-KT dementia by modifiable risk factors and CNIs among older recipients (n=28,901)
Crude sHR (95% CI) Ajusted sHR (95% CI)
Hypertension 1.02 (0.87, 1.20) 1.00 (0.85, 1.18)
Pre-KT Depression 2.37 (1.06, 2.72) 2.45 (2.13, 2.83)
Pre-KT Hearing Loss 1.45 (1.14, 1.86) 1.36 (1.07, 1.73)
Diabetes 1.37 (1.25, 1.50) 1.30 (1.11, 1.51)
No education (Reference: College education)
1.42 (0.96, 2.10) 1.47 (1.00, 2.15)
CNIs-Tacrolimus 1.42 (1.07, 1.88) 1.46 (1.10, 1.94)
CNIs-Cyclosporine 1.47 (1.05, 2.08) 1.54 (1.08, 2.14)

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To cite this abstract in AMA style:

Chen Y, Ahn J, Chu N, Bae S, Schnitzler MA, Hess G, Lentine K, Segev D, McAdams-DeMarco M. Post-Kidney Transplant Dementia Risk by Modifiable Risk Factors and CNIs Among Older Recipients [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/post-kidney-transplant-dementia-risk-by-modifiable-risk-factors-and-cnis-among-older-recipients/. Accessed May 29, 2025.

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