Nadia M Chu1,2, Alden L Gross3,4, Ashton A Shaffer3,2, Christine E Haugen2, Silas P Norman5, Qian-Li Xue3,6, A Richey Sharrett3, Michelle C Carlson3,4, Karen Bandeen-Roche7, Dorry L Segev3,2, Mara A McAdams-DeMarco1,2. 1. Departments of Epidemiology, nchu8@jhu.edu mara@jhu.edu. 2. Department of Surgery and. 3. Departments of Epidemiology. 4. Mental Health, and. 5. Division of Nephrology, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan. 6. Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland; and. 7. Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Abstract
BACKGROUND: Restoration of kidney function after kidney transplant generally improves cognitive function. It is unclear whether frail recipients, with higher susceptibility to surgical stressors, achieve such post-transplant cognitive improvements or whether they experience subsequent cognitive decline as they age with a functioning graft. METHODS: In this two-center cohort study, we assessed pretransplant frailty (Fried physical frailty phenotype) and cognitive function (Modified Mini-Mental State Examination) in adult kidney transplant recipients. To investigate potential short- and medium-term effects of frailty on post-transplant cognitive trajectories, we measured cognitive function up to 4 years post-transplant. Using an adjusted mixed effects model with a random slope (time) and intercept (person), we characterized post-transplant cognitive trajectories by pretransplant frailty, accounting for nonlinear trajectories. RESULTS: Of 665 recipients (mean age 52.0 years) followed for a median of 1.5 years, 15.0% were frail. After adjustment, pretransplant cognitive scores were significantly lower among frail patients compared with nonfrail patients (89.0 versus 90.8 points). By 3 months post-transplant, cognitive performance improved for both frail (slope =0.22 points per week) and nonfrail (slope =0.14 points per week) recipients. Between 1 and 4 years post-transplant, improvements plateaued among nonfrail recipients (slope =0.005 points per week), whereas cognitive function declined among frail recipients (slope =-0.04 points per week). At 4 years post-transplant, cognitive scores were 5.8 points lower for frail recipients compared with nonfrail recipients. CONCLUSIONS: On average, both frail and nonfrail recipients experience short-term cognitive improvement post-transplant. However, frailty is associated with medium-term cognitive decline post-transplant. Interventions to prevent cognitive decline among frail recipients should be identified.
BACKGROUND: Restoration of kidney function after kidney transplant generally improves cognitive function. It is unclear whether frail recipients, with higher susceptibility to surgical stressors, achieve such post-transplant cognitive improvements or whether they experience subsequent cognitive decline as they age with a functioning graft. METHODS: In this two-center cohort study, we assessed pretransplant frailty (Fried physical frailty phenotype) and cognitive function (Modified Mini-Mental State Examination) in adult kidney transplant recipients. To investigate potential short- and medium-term effects of frailty on post-transplant cognitive trajectories, we measured cognitive function up to 4 years post-transplant. Using an adjusted mixed effects model with a random slope (time) and intercept (person), we characterized post-transplant cognitive trajectories by pretransplant frailty, accounting for nonlinear trajectories. RESULTS: Of 665 recipients (mean age 52.0 years) followed for a median of 1.5 years, 15.0% were frail. After adjustment, pretransplant cognitive scores were significantly lower among frail patients compared with nonfrail patients (89.0 versus 90.8 points). By 3 months post-transplant, cognitive performance improved for both frail (slope =0.22 points per week) and nonfrail (slope =0.14 points per week) recipients. Between 1 and 4 years post-transplant, improvements plateaued among nonfrail recipients (slope =0.005 points per week), whereas cognitive function declined among frail recipients (slope =-0.04 points per week). At 4 years post-transplant, cognitive scores were 5.8 points lower for frail recipients compared with nonfrail recipients. CONCLUSIONS: On average, both frail and nonfrail recipients experience short-term cognitive improvement post-transplant. However, frailty is associated with medium-term cognitive decline post-transplant. Interventions to prevent cognitive decline among frail recipients should be identified.
Authors: A J Nastasi; M A McAdams-DeMarco; J Schrack; H Ying; I Olorundare; F Warsame; A Mountford; C E Haugen; M González Fernández; S P Norman; D L Segev Journal: Am J Transplant Date: 2017-08-30 Impact factor: 8.086
Authors: Mara A McAdams-DeMarco; Sunjae Bae; Nadia Chu; Alden L Gross; Charles H Brown; Esther Oh; Paul Rosenberg; Karin J Neufeld; Ravi Varadhan; Marilyn Albert; Jeremy Walston; Dorry L Segev Journal: J Am Soc Nephrol Date: 2016-12-15 Impact factor: 10.121
Authors: Alden L Gross; Qian-Li Xue; Karen Bandeen-Roche; Linda P Fried; Ravi Varadhan; Mara A McAdams-DeMarco; Jeremy Walston; Michelle C Carlson Journal: J Gerontol A Biol Sci Med Sci Date: 2016-04-15 Impact factor: 6.053
Authors: Mara A McAdams-DeMarco; Hao Ying; Israel Olorundare; Elizabeth A King; Christine Haugen; Brian Buta; Alden L Gross; Rita Kalyani; Niraj M Desai; Nabil N Dagher; Bonnie E Lonze; Robert A Montgomery; Karen Bandeen-Roche; Jeremy D Walston; Dorry L Segev Journal: Transplantation Date: 2017-09 Impact factor: 4.939
Authors: L Kramer; C Madl; F Stockenhuber; W Yeganehfar; E Eisenhuber; K Derfler; K Lenz; B Schneider; G Grimm Journal: Kidney Int Date: 1996-03 Impact factor: 10.612
Authors: Mara A McAdams-DeMarco; Kyra Isaacs; Louisa Darko; Megan L Salter; Natasha Gupta; Elizabeth A King; Jeremy Walston; Dorry L Segev Journal: J Am Geriatr Soc Date: 2015-09-29 Impact factor: 5.562
Authors: Mara A McAdams-DeMarco; Jonathan Konel; Fatima Warsame; Hao Ying; Marlís González Fernández; Michelle C Carlson; Derek M Fine; Lawrence J Appel; Dorry L Segev Journal: Kidney Int Rep Date: 2017-08-19
Authors: Calum D Moulton; Thahesh Tharmaraja; Jonathan L Dumbrill; Christopher W P Hopkins Journal: J Am Soc Nephrol Date: 2019-07-12 Impact factor: 10.121
Authors: Nadia M Chu; Alden L Gross; Ashton A Shaffer; Christine E Haugen; Silas P Norman; Qian-Li Xue; A Richey Sharrett; Michelle Carlson; Karen Bandeen-Roche; Dorry L Segev; Mara A McAdams-DeMarco Journal: J Am Soc Nephrol Date: 2019-07-12 Impact factor: 10.121
Authors: Nadia M Chu; Zhan Shi; Christine E Haugen; Silas P Norman; Alden L Gross; Daniel C Brennan; Michelle C Carlson; Dorry L Segev; Mara A McAdams-DeMarco Journal: Am J Kidney Dis Date: 2020-02-03 Impact factor: 8.860
Authors: Nadia M Chu; Xiaomeng Chen; Silas P Norman; Jessica Fitzpatrick; Stephen M Sozio; Bernard G Jaar; Alena Frey; Michelle M Estrella; Qian-Li Xue; Rulan S Parekh; Dorry L Segev; Mara A McAdams-DeMarco Journal: Am J Nephrol Date: 2020-07-08 Impact factor: 3.754
Authors: Elizabeth C Lorenz; LaTonya J Hickson; Renee M Weatherly; Karin L Thompson; Heidi A Walker; Judy M Rasmussen; Tara L Stewart; James K Garrett; Hatem Amer; Cassie C Kennedy Journal: Clin Transplant Date: 2020-07-24 Impact factor: 2.863
Authors: Christine E Haugen; Alvin G Thomas; Nadia M Chu; Ashton A Shaffer; Silas P Norman; Adam W Bingaman; Dorry L Segev; Mara McAdams-DeMarco Journal: Am J Transplant Date: 2019-12-12 Impact factor: 8.086
Authors: Christine E Haugen; Alden Gross; Nadia M Chu; Silas P Norman; Daniel C Brennan; Qian-Li Xue; Jeremy Walston; Dorry L Segev; Mara McAdams-DeMarco Journal: J Gerontol A Biol Sci Med Sci Date: 2021-02-25 Impact factor: 6.053