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Randomized Controlled Trial
. 2018 Mar;18(3):696-703.
doi: 10.1111/ajt.14570. Epub 2017 Nov 26.

Postoperative cognitive dysfunction and mortality following lung transplantation

P J Smith  1 , J A Blumenthal  1 , B M Hoffman  1 , R D Davis  2 , S M Palmer  3
Affiliations
Randomized Controlled Trial

Postoperative cognitive dysfunction and mortality following lung transplantation

P J Smith et al. Am J Transplant. 2018 Mar.

Abstract

Preliminary evidence suggests that postoperative cognitive dysfunction (POCD) is common after lung transplantation. The impact of POCD on clinical outcomes has yet to be studied. The association between POCD and longer-term survival was therefore examined in a pilot study of posttransplantation survivors. Forty-nine participants from a prior randomized clinical trial underwent a neurocognitive assessment battery pretransplantation and 6 months posttransplantation, including assessments of the domains of Executive Function (Trail Making Test, Stroop, Digit Span), Processing Speed (Ruff 2 and 7 Test, Digit Symbol Substitution Test), and Verbal Memory (Verbal Paired Associates, Logical Memory, Animal Naming, and Controlled Oral Word Association Test). During a 13-year follow-up, 33 (67%) participants died. Greater neurocognition was associated with longer survival (hazard ratio [HR] = 0.49 [0.25-0.96], P = .039), and this association was strongest on tests assessing Processing Speed (HR = 0.58 [0.36-0.95], P = .03) and Executive Function (HR = 0.52 [0.28-0.97], P = .040). In addition, unadjusted analyses suggested an association between greater Memory performance and lower risk of CLAD (HR = 0.54 [0.29-1.00], P = .050). Declines in Executive Function tended to be predictive of worse survival. These preliminary findings suggest that postoperative neurocognition is predictive of subsequent mortality among lung transplant recipients. Further research is needed to confirm these findings in a larger sample and to examine mechanisms responsible for this relationship.

Keywords: allied health/nursing; clinical research/practice; lung disease; transplant social worker.

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Conflict of interest statement

Disclosure

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Figures

Figure 1
Figure 1
Neurocognitive test performance averaged across all subtests within all domains, including Processing Speed, Executive Function, and Verbal Memory. Data are presented in Tertiles, in which the composite z-score of neurocognitive test performance across all domains was partitioned into thirds based on performance within the sample.
See this image and copyright information in PMC

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