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

Abstract

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. We evaluated pre- to post-KT cognitive function with theMontreal 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. 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. 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.