Journal Article Annotations
2023, 1st Quarter
Annotations by Sarah Andrews, MD and Gregory Nikogosyan, DO
Kidney Transplant Recipients (KTR) had significantly lower scores in all cognitive domains at an average 11-year post-transplant measurement point. Furthermore, 16% of KTR met internationally accepted criteria for mild cognitive impairment (MCI), defined as a 1.5 standard deviation decrease from the normative mean on at least two neuropsychological tests within the battery. Decreased cognitive function was also shown to have a serious negative impact on societal participation and quality of life (QoL) measured by Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P) and Medical Outcomes Study Short-Form 36 (SF-36) respectively.
Strength and weaknesses:
The authors describe cognitive outcomes at a longer time after transplantation compared to other previous studies in this topic area. Cognitive impairment does not improve as expected post-transplantation and the impairment appears to be stable based on these results, but this was implicitly determined by showing no relationship between the time of transplantation and the presence of neuropsychological deficits. It was determined furthermore that there was no significant relation between MCI and other variables (age, duration of dialysis before transplantation, eGFR, pre-transplant health status, and immunosuppressant drugs). It is unclear about the which percentage of invited candidates for the study became participants. To what degree would more cognitively impaired candidates be unable to agree to participate or decide to refuse participation? This study was not able to determine the cognitive status of KTR in the pre-transplantation or sub-acute stage of post-transplantation which would have more reliably determined if cognitive function worsens, improves, or remains the same after surgery.
Routine neurocognitive testing can help identify the pervasive cognitive impairment in KTR. This will allow multidisciplinary treatment teams to provide adequate counselling, management, and efforts to prevent decreased levels of participation and QoL.
Health disparities, unfortunately, have been well-documented in different medical environments, including within the liver transplantation (LT) process. The goal of this single-center cohort study was the determine if there are any racial and ethnic inequities for candidates regarding listing for LT. Although the study did not find disparities between race/ethnicity for listing or not listing based on medical reasons, there were disparities when based on psychosocial reasons. Even after adjusting for psychosocial covariates, Black race and Hispanic/Latinx ethnicity were still associated with increased risk of not being listed due to psychosocial reasons. This study suggested that Black patients may be more affected by high-risk total Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) compared to White patients.
Strength and weaknesses:
The strengths of the study included a large sample size of over 2200 patients who were evaluated for LT. The study also included detailed psychosocial data with SIPAT scores. The limitations included that it was only a single-center design study. Even though the study evaluated race inequity in LT waitlist decisions, there was not evaluation of racial inequities with the referral process.
This study demonstrates the importance of evaluating structural racism that is evident in the LT process.