Departments of Epidemiology,
Department of Surgery and.
J Am Soc Nephrol. 2019 Feb;30(2):336-345. doi: 10.1681/ASN.2018070726. Epub 2019 Jan 24.
Restoration of kidney function after kidney transplant generally improves cognitive function. It is unclear whether frail recipients, with higher susceptibility to surgical stressors, achieve such post-transplant cognitive improvements or whether they experience subsequent cognitive decline as they age with a functioning graft.
In this two-center cohort study, we assessed pretransplant frailty (Fried physical frailty phenotype) and cognitive function (Modified Mini-Mental State Examination) in adult kidney transplant recipients. To investigate potential short- and medium-term effects of frailty on post-transplant cognitive trajectories, we measured cognitive function up to 4 years post-transplant. Using an adjusted mixed effects model with a random slope (time) and intercept (person), we characterized post-transplant cognitive trajectories by pretransplant frailty, accounting for nonlinear trajectories.
Of 665 recipients (mean age 52.0 years) followed for a median of 1.5 years, 15.0% were frail. After adjustment, pretransplant cognitive scores were significantly lower among frail patients compared with nonfrail patients (89.0 versus 90.8 points). By 3 months post-transplant, cognitive performance improved for both frail (slope =0.22 points per week) and nonfrail (slope =0.14 points per week) recipients. Between 1 and 4 years post-transplant, improvements plateaued among nonfrail recipients (slope =0.005 points per week), whereas cognitive function declined among frail recipients (slope =-0.04 points per week). At 4 years post-transplant, cognitive scores were 5.8 points lower for frail recipients compared with nonfrail recipients.
On average, both frail and nonfrail recipients experience short-term cognitive improvement post-transplant. However, frailty is associated with medium-term cognitive decline post-transplant. Interventions to prevent cognitive decline among frail recipients should be identified.
肾移植后肾功能的恢复通常会改善认知功能。目前尚不清楚，身体虚弱的受者（对手术应激源的敏感性更高）是否能在移植后获得认知改善，或者随着移植肾的功能正常而衰老，他们是否会出现随后的认知下降。
在这项两中心队列研究中，我们评估了成年肾移植受者移植前的虚弱状态（弗里德身体虚弱表型）和认知功能（改良简易精神状态检查）。为了研究虚弱对移植后认知轨迹的潜在短期和中期影响，我们在移植后长达 4 年的时间内测量了认知功能。使用具有随机斜率（时间）和截距（个体）的调整后的混合效应模型，我们根据移植前的虚弱状态描述了移植后的认知轨迹，考虑了非线性轨迹。
在中位随访时间为 1.5 年的 665 名受者（平均年龄为 52.0 岁）中，有 15.0%的人虚弱。调整后，与非虚弱患者相比，虚弱患者的移植前认知评分显著降低（89.0 分比 90.8 分）。移植后 3 个月，虚弱患者（斜率=每周 0.22 分）和非虚弱患者（斜率=每周 0.14 分）的认知表现均有所改善。在移植后 1 至 4 年期间，非虚弱受者的改善趋于平稳（斜率=每周 0.005 分），而虚弱受者的认知功能下降（斜率=每周-0.04 分）。在移植后 4 年时，虚弱受者的认知评分比非虚弱受者低 5.8 分。
平均而言，虚弱和非虚弱的受者在移植后都经历了短期的认知改善。然而，虚弱与移植后中期的认知下降有关。应确定预防虚弱受者认知能力下降的干预措施。
