Cognitive Impairment in CMV Seropositive and CMV Seronegative Deceased Donor Kidney Transplant Recipients

Kidney transplant recipients (KTRs) experience a high burden of cytomegalovirus infection (CMV R⁺) and long-term premature cognitive aging. We tested whether CMV was associated with post-KT cognitive impairment.

In a 2-center prospective cohort study of 574 KTRs (mean age: 54.7 y), we obtained CMV donor/recipient (D/R) serostatus and measured pre- and post-KT cognitive function using the Modified Mini-Mental State Examination. We estimated post-KT global cognitive function trajectories by CMV serostatus using adjusted mixed effect models with linear spline terms.

Two hundred twenty-two (38.6%) recipients were CMV D⁺/R⁺, 100 (17.4%) were CMV D⁺/R^-, 153 (26.6%) were CMV D^-/R⁺, and 99 (17.2%) were CMV D^-/R^-. At the time of KT, there were no significant differences in global cognitive function scores among KTRs irrespective of CMV D/R status. Cognitive function equally improved in all CMV D/R groups during the first 3 y post-KT (slope = 0.62 points/year; 95% confidence interval [CI], 0.17-1.07). However, during years 3-8 post-KT, the global cognitive function score trajectories significantly declined in the CMV D⁺/R⁺ KTRs (slope = -3.51 points/year; 95% CI, -5.07 to -1.95) but not in the other groups, including CMV D^-/R^- (slope = 0.44 points/year; 95% CI, -2.12 to 3.00; P = 0.01), CMV D^-/R⁺ (slope = 0.13 points/year; 95% CI, -1.83 to 2.09), or CMV D⁺/R^- (slope = 0.01 points/year; 95% CI, -1.87 to 1.89).

CMV D⁺/R⁺ KTRs may be at elevated risk for post-KT cognitive impairment; clinicians may prioritize early interventions in this population.