Kidney Transplant Outcomes in Recipients With Cognitive Impairment: A National Registry and Prospective Cohort Study
| Autor: | Silas P. Norman, Alden L. Gross, Jessica M. Ruck, Nadia M. Chu, Alvin G. Thomas, Dorry L. Segev, Mara McAdams-DeMarco, Ashton A. Shaffer, Fatima Warsame, Hao Ying, Michelle C. Carlson, Christine E. Haugen |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors medicine.medical_treatment Disease Article Cognition Risk Factors Internal medicine Living Donors Prevalence medicine Humans Cognitive Dysfunction Longitudinal Studies Prospective Studies Registries Prospective cohort study Dialysis Transplantation Proportional hazards model business.industry Graft Survival Hazard ratio Middle Aged Kidney Transplantation Transplant Recipients United States Confidence interval Treatment Outcome Cohort Kidney Failure Chronic Female business |
| Zdroj: | Transplantation |
| ISSN: | 0041-1337 |
| DOI: | 10.1097/tp.0000000000002431 |
| Popis: | BACKGROUND Cognitive impairment is common in patients with end-stage renal disease and is associated with poor outcomes on dialysis. We hypothesized that cognitive impairment might be associated with an increased risk of all-cause graft loss (ACGL) in kidney transplant (KT) recipients. METHODS Using the Modified Mini-Mental State (3MS) examination, we measured global cognitive function at KT hospital admission in a prospective, 2-center cohort of 864 KT candidates (August 2009 to July 2016). We estimated the association between pre-KT cognitive impairment and ACGL using Cox regression, adjusting for recipient, donor, and transplant factors. RESULTS In living donor KT (LDKT) recipients, the prevalence was 3.3% for mild impairment (60 ≤ 3MS < 80) and 3.3% for severe impairment (3MS < 60). In deceased donor KT (DDKT) recipients, the prevalence was 9.8% for mild impairment and 2.6% for severe impairment. The LDKT recipients with cognitive impairment had substantially higher ACGL risk than unimpaired recipients (5-year ACGL: 45.5% vs 10.6%; P < 0.01; adjusted hazard ratio [aHR] any impairment, 5.40 (95% confidence interval [CI], 1.78-16.34; P < 0.01); aHR severe impairment, 5.57 (95% CI, 1.29-24.00; P = 0.02). Similarly, 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, 2.92 (95% CI, 1.13-7.50; P = 0.03). CONCLUSIONS Given the elevated risk of ACGL among KT recipients with cognitive impairment observed in this 2-center cohort, research efforts should explore the mechanisms of graft loss and mortality associated with cognitive impairment and identify potential interventions to improve posttransplant survival. |
| Databáze: | OpenAIRE |
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