Transplant Institute.
Internal Medicine, Henry Ford Health, Detroit, Michigan.
Curr Opin Organ Transplant. 2022 Dec 1;27(6):523-529. doi: 10.1097/MOT.0000000000001021. Epub 2022 Sep 9.
Cognitive impairment is associated with negative effects on solid organ transplant candidates, recipients, and their care partners. However, because of the heterogeneity of mechanisms, presentations, and assessment measures, research suggests a wide array of impairments, patterns of impairments, and unclear trajectories posttransplant. This review provides an abbreviated synthesis of recent research on cognitive impairments observed in organ-eligible candidates and potential trajectories through posttransplant, current clinical recommendations regarding integration of assessment into routine clinical transplant practice, as well as recommendations for future research.
Transplantation may resolve certain disease-contributing factors to cognitive impairments but also introduces new potential neurocognitive assaults. Recent studies in kidney and lung recipients document continued impairments in subsets of patients, particularly those identified as frail. For liver candidates, new assessment measures of hepatic encephalopathy have been developed and preliminarily tested with potential for translation into routine clinical care. Clinical implications, as well as ethical considerations are discussed.
Although guidelines agree that cognitive assessment is an important part of the organ transplantation process, many questions remain of how to best assess cognition and intervene when cognitive impairment is identified in transplant populations. Further research should focus on prospective, longitudinal assessments in transplant-eligible populations through posttransplant.
目的综述：认知障碍与实体器官移植候选者、受者及其护理伙伴的负面后果相关。然而，由于机制、表现和评估措施的异质性，研究表明移植后存在广泛的认知障碍、障碍模式和不明确的轨迹。本综述简要总结了近期关于器官合格候选者中观察到的认知障碍以及潜在轨迹的研究，目前关于将评估纳入常规临床移植实践的临床建议，以及对未来研究的建议。
最新发现：移植可能会消除导致认知障碍的某些因素，但也会带来新的潜在神经认知挑战。最近对肾和肺移植受者的研究记录了某些患者，尤其是那些被认定为体弱的患者，持续存在认知障碍。对于肝候选者，已经开发了新的肝性脑病评估措施，并初步进行了测试，具有转化为常规临床护理的潜力。讨论了临床意义和伦理考虑。
总结：尽管指南一致认为认知评估是器官移植过程的重要组成部分，但在移植人群中识别出认知障碍时，如何最好地评估认知和进行干预仍存在许多问题。进一步的研究应侧重于通过移植后对移植合格人群进行前瞻性、纵向评估。
