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 (p_interaction=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 (p_interaction=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)

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 October 30, 2024.

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