Gupta Aditi, Grasing Michael J, Young Kate J, Montgomery Robert N, Murillo Daniel J, Cibrik Diane M
Division of Nephrology and Hypertension, Department of Internal Medicine and Neurology, University of Kansas Medical Center, Kansas City, KS.
Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS.
Kidney Med. 2024 Jul 22;6(9):100872. doi: 10.1016/j.xkme.2024.100872. eCollection 2024 Sep.
BACKGROUND & HYPOTHESIS: Cognitive impairment is common in patients being evaluated for a kidney transplant (KT). The association between pretransplant cognitive function and posttransplant outcomes is unclear.
We performed a prospective cohort study to assess the association between pretransplant cognitive function and clinically relevant posttransplant outcomes.
In this single center study, participants from the transplant clinic were evaluated during their pretransplant clinic visits and followed prospectively.
Our primary outcome measure was allograft function. Secondary outcomes were length of hospitalization for KT, hospital readmission within 30 and 90 days, graft loss, graft rejection within 90 days and 1 year, and mortality.
We measured cognitive function with the Montreal Cognitive Assessment (MoCA) test. We assessed the association of pretransplant MoCA score with posttransplant outcomes; we used linear mixed effects models to assess the association with the change in estimated glomerular filtration rate, Poisson regression for length of hospitalization, Cox proportional hazard model for graft loss and mortality, and a logistic regression model for readmission and rejection.
We followed 501 participants for 2.7 ± 1.5 years. The mean age of the patients was 53 ± 14 years and the mean pretransplant MoCA score was 25 ± 3. Lower pretransplant MoCA scores did not adversely affect the primary outcome of allograft function or the secondary outcomes. Although higher MoCA scores predicted a higher decline in graft function (β = -0.28, 95% CI: -0.55 to -0.01, = 0.04), the effect was small and not clinically significant. Older age was associated with longer hospitalization, lower likelihood of rejection, and higher mortality. Deceased donor KT (vs living donor KT) was associated with longer hospitalization but better graft function. Longer time receiving dialysis before KT was associated with longer hospitalization. A history of diabetes mellitus was associated with higher mortality.
Single center study limiting generalizability.
Pretransplant MoCA scores were not associated with the primary outcome of allograft function or the secondary outcomes.
在接受肾移植（KT）评估的患者中，认知障碍很常见。移植前认知功能与移植后结局之间的关联尚不清楚。
我们进行了一项前瞻性队列研究，以评估移植前认知功能与临床上相关的移植后结局之间的关联。
在这项单中心研究中，对移植诊所的参与者在移植前门诊就诊时进行评估，并进行前瞻性随访。
我们的主要结局指标是同种异体移植功能。次要结局包括KT后的住院时间、30天和90天内的再次入院、移植物丢失、90天和1年内的移植物排斥反应以及死亡率。
我们使用蒙特利尔认知评估（MoCA）测试来测量认知功能。我们评估了移植前MoCA评分与移植后结局之间的关联；我们使用线性混合效应模型来评估与估计肾小球滤过率变化的关联，使用泊松回归分析住院时间，使用Cox比例风险模型分析移植物丢失和死亡率，使用逻辑回归模型分析再次入院和排斥反应。
我们对501名参与者进行了2.7±1.5年的随访。患者的平均年龄为53±14岁，移植前MoCA评分的平均值为25±3。较低的移植前MoCA评分并未对同种异体移植功能的主要结局或次要结局产生不利影响。尽管较高的MoCA评分预示着移植物功能下降幅度更大（β=-0.28，95%置信区间：-0.55至-0.01，P=0.04），但这种影响很小且无临床意义。年龄较大与住院时间较长、排斥反应可能性较低以及死亡率较高相关。 deceased donor KT（与活体供体KT相比）与住院时间较长但移植物功能较好相关。KT前接受透析的时间较长与住院时间较长相关。糖尿病病史与较高的死亡率相关。
单中心研究限制了研究结果的普遍性。
移植前MoCA评分与同种异体移植功能的主要结局或次要结局无关。
