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Cognitive Function Among Heart Transplant Recipients Before and After Intravenous Iron Supplement for Iron
Britta S Bürker1,2, Kristine V Brautaset Englund2,3, Charlotte Myrdal Østby2
1Norwegian National Unit for Sensory Loss and Mental Health, Oslo University Hospital, Oslo, Norway.
Insights
A single intravenous iron supplement did not improve cognitive function in heart transplant recipients after six months. Cognitive screening is recommended for these patients due to observed deficits.
Area of Science:
- Cardiology
- Neurology
- Transplantation Medicine
Background:
- Cognitive dysfunction is common after heart transplantation (HTx).
- Lower hemoglobin levels are linked to cognitive issues in HTx recipients.
- This study investigated iron supplementation's effect on post-transplant cognition.
Purpose of the Study:
- To determine if a single intravenous iron supplement improves cognitive function in iron-deficient heart transplant recipients.
- To assess changes in cognitive function 6 months after iron supplementation.
Main Methods:
- The study involved 94 heart transplant recipients with cognitive data at baseline and 6 months.
- Participants were randomized to receive either a single intravenous iron supplement or a placebo.
- Cognitive function was assessed using the Cambridge Neuropsychological Test Automated Battery.
Main Results:
- No statistically significant differences in cognitive function were observed between the iron supplement and placebo groups.
- A significant proportion of participants (27%-44%) had baseline cognitive performance below the normative mean.
- Exploratory analysis suggested age may negatively impact memory performance over time.
Conclusions:
- A single intravenous iron supplement did not lead to significant cognitive improvements in heart transplant recipients.
- Heart transplant recipients often exhibit cognitive deficits in memory and executive functions.
- Regular cognitive screening is advised for heart transplant recipients post-surgery.
Background:
Cognitive dysfunction after successful heart transplantation (HTx) is not uncommon. Lower hemoglobin levels have previously been associated with cognitive dysfunction in heart transplant recipients (HTx recipients). In a randomized, placebo-controlled, double-blind treatment trial, we assessed as a pre-specified secondary outcome whether a single intravenous iron supplement for iron deficiency in HTx recipients resulted in changes in cognitive function after 6 months.
Methods:
In the "Intravenous Iron Supplement for Iron Deficiency in Cardiac Transplant Recipients" (IronIC) trial, we assessed cognitive function at baseline and at 6-month follow-up with the following tests of the Cambridge Neuropsychological Test Automated Battery: Reaction Time, Paired Associates Learning, and Spatial Working Memory. Of 94 participants with cognitive data at baseline and follow-up, 49 were randomized to the single intravenous iron supplement, while 45 received placebo.
Results:
Raw score changes from baseline to follow-up did not differ statistically significantly between study groups (two measures of each test analyzed). In the total sample, 27%-44% of participants performed at baseline at least one standard deviation below the normative mean on measures of memory and working memory/executive functions. Exploratory analyses indicated that performance on measures of memory might decrease more than expected with increasing age.
Conclusion:
A single intravenous iron supplement for iron deficiency in HTx recipients did not result in statistically significant cognitive changes after 6 months. The group as a whole performed approximately half a standard deviation below the normative mean on measures of memory and working memory/executive functions. Regular cognitive screening after HTx is recommended.
Clinical Trial Registration:
Trial Registration: ClinicalTrials.gov identifier: NCT03662789.
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