Department of Surgery, New York University Grossman School of Medicine and Langone Health, New York, New York, USA.
Department of Medicine, New York University Grossman School of Medicine and Langone Health, New York, New York, USA.
Clin Transplant. 2024 Nov;38(11):e70018. doi: 10.1111/ctr.70018.
Kidney transplant (KT) candidates often experience hospitalizations, increasing their delirium risk. Hospitalizations and delirium are associated with worse post-KT outcomes, yet their relationship with pre-KT outcomes is less clear. Pre-KT delirium may worsen access to KT due to its negative impact on cognition and ability to maintain overall health.
Using a prospective cohort of 2374 KT candidates evaluated at a single center (2009-2020), we abstracted hospitalizations and associated delirium records after listing via chart review. We evaluated associations between waitlist mortality and likelihood of KT with hospitalizations and hospitalized delirium using competing risk models and tested whether associations differed by gerontologic factors.
During a median of 1.8 years after listing, 735 (31.0%) candidates had ≥1 hospitalizations. Candidates with less education, frailty, depressive symptoms, and lower extremity function impairment were more likely to be hospitalized. Hospitalization was associated with higher waitlist mortality (aSHR = 3.65, 95% CI: 2.99-4.45) and a lower likelihood of KT (aSHR = 0.74, 95% CI: 0.66-0.84). Among candidates who were hospitalized, 80 (11%) had ≥1 delirium episodes. Candidates who were older, frail, and impaired in lower extremity function were more likely to have delirium, which was associated with higher waitlist mortality (aSHR = 4.87, 95% CI: 3.42-6.93) and a lower likelihood of KT (aSHR = 0.45, 95% CI: 0.27-0.74). The association between hospitalization and KT differed by candidate age (p < 0.001), with those aged ≥65 having a 61% lower likelihood of KT.
Hospitalization and delirium are associated with worse pre-KT outcomes and have serious implications on candidates' access to KT. Providers should work to reduce preventable instances of delirium.
肾移植（KT）候选人经常住院，增加了他们患谵妄的风险。住院和谵妄与移植后更差的结果相关，但其与移植前结果的关系尚不清楚。移植前谵妄可能会因对认知和整体健康维持能力的负面影响而影响到获得 KT 的机会。
使用单中心 2374 名 KT 候选者的前瞻性队列（2009-2020 年），通过图表审查，我们在列名后提取了住院和相关谵妄记录。我们使用竞争风险模型评估了住院和住院谵妄与等待名单死亡率和 KT 可能性之间的关联，并测试了这些关联是否因老年因素而有所不同。
在列名后中位数为 1.8 年的时间内，735 名（31.0%）候选人至少有 1 次住院。受教育程度较低、脆弱、有抑郁症状和下肢功能障碍的候选人更有可能住院。住院与更高的等待名单死亡率（aSHR = 3.65，95%CI：2.99-4.45）和 KT 可能性降低（aSHR = 0.74，95%CI：0.66-0.84）相关。在住院的候选人中，有 80 人（11%）至少有 1 次谵妄发作。年龄较大、脆弱和下肢功能障碍的候选人更有可能发生谵妄，这与更高的等待名单死亡率（aSHR = 4.87，95%CI：3.42-6.93）和 KT 可能性降低（aSHR = 0.45，95%CI：0.27-0.74）相关。住院与 KT 的关联因候选者年龄而异（p < 0.001），年龄≥65 岁的候选者 KT 的可能性降低 61%。
住院和谵妄与移植前结果较差相关，并对候选者获得 KT 的机会产生严重影响。提供者应努力减少可预防的谵妄病例。
