Abidi Maheen Z, Chen Xiaomeng, Liu Yi, Chu Nadia M, Mathur Aarti, Weinberg Adriana, Kaplan Bruce, Norman Silas, Hong Jingyao, Segev Dorry L, Erlandson Kristine M, McAdams-DeMarco Mara A
Division of Infectious Diseases, Department of Medicine, University of Colorado, Denver, CO.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Transplant Direct. 2025 Aug 8;11(9):e1818. doi: 10.1097/TXD.0000000000001818. eCollection 2025 Sep.
Kidney transplant recipients (KTRs) experience a high burden of cytomegalovirus infection (CMV R) and long-term premature cognitive aging. We tested whether CMV was associated with post-KT cognitive impairment.
In a 2-center prospective cohort study of 574 KTRs (mean age: 54.7 y), we obtained CMV donor/recipient (D/R) serostatus and measured pre- and post-KT cognitive function using the Modified Mini-Mental State Examination. We estimated post-KT global cognitive function trajectories by CMV serostatus using adjusted mixed effect models with linear spline terms.
Two hundred twenty-two (38.6%) recipients were CMV D/R, 100 (17.4%) were CMV D/R, 153 (26.6%) were CMV D/R, and 99 (17.2%) were CMV D/R. At the time of KT, there were no significant differences in global cognitive function scores among KTRs irrespective of CMV D/R status. Cognitive function equally improved in all CMV D/R groups during the first 3 y post-KT (slope = 0.62 points/year; 95% confidence interval [CI], 0.17-1.07). However, during years 3-8 post-KT, the global cognitive function score trajectories significantly declined in the CMV D/R KTRs (slope = -3.51 points/year; 95% CI, -5.07 to -1.95) but not in the other groups, including CMV D/R (slope = 0.44 points/year; 95% CI, -2.12 to 3.00; = 0.01), CMV D/R (slope = 0.13 points/year; 95% CI, -1.83 to 2.09), or CMV D/R (slope = 0.01 points/year; 95% CI, -1.87 to 1.89).
CMV D/R KTRs may be at elevated risk for post-KT cognitive impairment; clinicians may prioritize early interventions in this population.
肾移植受者（KTRs）经历巨细胞病毒感染（CMV R）的高负担和长期过早的认知衰老。我们测试了CMV是否与肾移植术后认知障碍有关。
在一项对574名KTRs（平均年龄：54.7岁）进行的2中心前瞻性队列研究中，我们获得了CMV供体/受体（D/R）血清学状态，并使用改良简易精神状态检查表测量肾移植前后的认知功能。我们使用带有线性样条项的调整混合效应模型，按CMV血清学状态估计肾移植术后的整体认知功能轨迹。
222名（38.6%）受者为CMV D/R，100名（17.4%）为CMV D/R，153名（26.6%）为CMV D/R，99名（17.2%）为CMV D/R。在肾移植时，无论CMV D/R状态如何，KTRs之间的整体认知功能评分均无显著差异。在肾移植后的前3年，所有CMV D/R组的认知功能均同样改善（斜率=0.62分/年；95%置信区间[CI]，0.17 - 1.07）。然而，在肾移植后的3 - 8年，CMV D/R的KTRs的整体认知功能评分轨迹显著下降（斜率=-3.51分/年；95% CI，-5.07至-1.95），而其他组包括CMV D/R（斜率=0.44分/年；95% CI，-2.12至3.00；P = 0.01）、CMV D/R（斜率=0.13分/年；95% CI，-1.83至2.09）或CMV D/R（斜率=0.01分/年；95% CI，-1.87至1.89）则没有下降。
CMV D/R的KTRs可能有更高的肾移植术后认知障碍风险；临床医生可能会优先对该人群进行早期干预。
