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Postoperative cognitive dysfunction and mortality following lung transplantation.

P J Smith1, J A Blumenthal1, B M Hoffman1

  • 1Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|November 1, 2017
PubMed
Summary

Postoperative cognitive dysfunction after lung transplantation impacts survival. Better cognitive function, especially processing speed and executive function, is linked to longer survival in lung transplant recipients.

Keywords:
allied health/nursingclinical research/practicelung diseasetransplant social worker

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Area of Science:

  • Transplantation Medicine
  • Neuroscience
  • Clinical Outcomes Research

Background:

  • Postoperative cognitive dysfunction (POCD) is a recognized concern following major surgeries, including lung transplantation.
  • The long-term clinical impact, particularly on survival, of POCD after lung transplantation remains understudied.

Purpose of the Study:

  • To investigate the association between neurocognitive function assessed post-lung transplantation and long-term patient survival.
  • To identify specific cognitive domains that may predict mortality risk in lung transplant survivors.

Main Methods:

  • A pilot study involving 49 lung transplant survivors who underwent neurocognitive assessments pre-transplantation and at 6 months post-transplantation.
  • Cognitive domains assessed included Executive Function, Processing Speed, and Verbal Memory.
  • A 13-year follow-up period was used to track mortality.

Main Results:

  • Higher neurocognitive performance was significantly associated with longer survival (HR=0.49, P=0.039).
  • This association was most pronounced for Processing Speed (HR=0.58, P=0.03) and Executive Function (HR=0.52, P=0.040).
  • Memory performance showed a trend towards association with a lower risk of chronic lung allograft dysfunction (CLAD) (HR=0.54, P=0.050).

Conclusions:

  • Postoperative neurocognitive function appears to be a significant predictor of long-term mortality in lung transplant recipients.
  • Executive function decline may be particularly predictive of worse survival outcomes.
  • Further research with larger cohorts is warranted to confirm these findings and explore underlying mechanisms.