Delirium Among Adults Undergoing Solid Organ Transplantation

Area of Science:

• Transplant Medicine
• Critical Care Medicine
• Geriatrics

Background:

• Delirium is a frequent complication in organ failure patients, occurring before and after solid organ transplantation (4.7-47%).
• It is often unrecognized and underdiagnosed due to variable presentation, despite close post-operative monitoring.
• Delirium arises from multifactorial causes, including recipient, donor, and transplant-specific factors, alongside intraoperative and perioperative influences.

Purpose of the Study:

• To review existing research on post-operative delirium in solid organ transplant recipients.
• To enhance the recognition, evaluation, and management of delirium in this patient population.
• To identify future research directions for addressing delirium in transplant patients.

Main Methods:

• Literature review of studies on post-operative delirium in solid organ transplantation.
• Synthesis of evidence regarding delirium etiology, risk factors, and adverse outcomes.
• Analysis of prevention strategies for delirium in general hospitalized populations.

Main Results:

• Delirium is associated with increased hospital length of stay, ICU duration, mechanical ventilation time, graft dysfunction, graft loss, and mortality.
• While specific trials in transplant populations are lacking, delirium is generally preventable in hospitalized older adults.
• Multicomponent primary prevention strategies targeting factors like cognitive impairment, sleep deprivation, immobility, sensory deficits, and dehydration are effective.

Conclusions:

• Delirium is a significant, common, and potentially preventable complication in organ transplant candidates and recipients.
• Further research is essential to evaluate the effectiveness of multicomponent prevention strategies on long-term health outcomes in this vulnerable group.