The Relationship of Pre-Kidney Transplant Cognitive Function and Post-Kidney Transplant Medical and Biological Outcomes

Document Type

Conference Proceeding

Publication Date

8-1-2025

Publication Title

Am J Transplant

Abstract

Purpose: Pre-transplant cognitive function (CF) in kidney transplant (KT) recipients is emerging as an important component of the KT evaluation. However, the effect of pre-KT CF on post-KT medical outcomes is not clear. We sought to better understand the effect of pre-KT CF on post-KT patient and graft survival and biological outcomes by conducting a systematic review of the available literature. Methods: We conducted a systematic review based on a query of "cognitive function in kidney transplantation." Literature was reviewed and screened as demonstrated in Figure 1. Key inclusion criteria were that studies included for final review had to measure CF both pre and post KT and report on medical outcomes. Results: We identified 24 studies which reported on the relationship between pre-KT CF and post-KT medical outcomes. Only one found a relationship between global pre-KT cognitive impairment and post-KT all cause graft loss. One study identified pre-KT cognitive impairment in the domain of executive function as a risk factor for post-KT mortality. No studies found a correlation between pre-KT global CF and post-KT changes in biochemical markers such as BUN, Cr, hemoglobin, or blood pressure. Seven of 24 studies reported on the relationship of domain specific pre-KT CF and post-KT neuro-imaging, neuro-functional, neural biochemical marker findings with all seven studies correlating pre-KT CF in the domains of executive function and psychomotor speed with changes seen in imaging, functional, or marker studies. Conclusions: This comprehensive systematic review demonstrates the limited data on the relationship of pre-KT CF on post-KT medical outcomes. The data is further limited in that some studies that met the inclusion criteria utilized global measures to test CF while others utilized only domain specific testing. Studies examining neural function, neuro-imaging, neural specific biochemical markers demonstrated a consistent physiologic relationship between pre-KT domain specific CF and biologic outcomes. This suggests that pre-KT CF is correlated with physiologic changes in the CKD/ESRD population. However, when examining pre-KT global CF and post-KT medical outcomes, no relationship emerged. As cognitive impairment is associated with increased mortality in the pre-KT population, these findings suggests more work is needed to define the nature of cognitive impairment in the pre-KT population to better guide clinical care in both the pre-KT and post-KT settings. [Formula presented] CITATION INFORMATION: Dar W., Ng Y., Haver D., Jesse M., Engel K. The Relationship of Pre-Kidney Transplant Cognitive Function and Post-Kidney Transplant Medical and Biological Outcomes AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: W. Dar: None.

Volume

25

Issue

8

First Page

S516

Last Page

S517

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