Pre-transplant cognitive screening is a poor predictor of post-transplant cognitive status

Abstract

Introduction: Transplant centers hesitate to transplant patients with cognitive impairment. It is unclear if pre-kidney transplant (KT) cognitive screening can predict post-KT cognitive function.

Methods: We evaluated pre- to post-KT cognitive function with the Montreal Cognitive Assessment (MoCA) in a cohort of 108 patients. We used an adjusted logistic regression model to assess pre- to post-KT changes in cognitive status (continuous variable) and a linear mixed model to assess changes in MoCA scores (categorical variable) pre- to post- KT.

Results: The average pre- and post-KT MoCA scores were 25.3 ± 3.0 and 26.4 ± 2.8, respectively. Final pre-KT score did not predict post-KT cognitive status (OR = 1.08; 95% CI: .92-1.26; P = .35). 32% of the patients with a final pre-KT score ≥26 had at least one post-KT score < 26. Conversely, 61% of the patients with a final pre-KT score < 26 had at least one post KT score ≥26. In the linear mixed model analysis, the final pre-KT score was associated with a small, clinically insignificant (β = .34; 95% CI: .19-.49; P < .001) effect on the post-KT score.

Conclusion: A low pre-KT MoCA score is not a strong independent predictor of post-KT cognitive function and should not preclude patients from receiving a KT.

Keywords: MoCA; cognition; end stage kidney disease; kidney transplantation; transplant eligibility.

Figure 1:

Pre- to post-kidney transplant Montreal cognitive assessment (MoCA) scores for a) all 108 participants and b) patients with final pre-transplant MoCA score of ≤24.

Figure 1:

Pre- to post-kidney transplant Montreal cognitive assessment (MoCA) scores for a) all 108 participants and b) patients with final pre-transplant MoCA score of ≤24.