Characteristics and Outcomes of Deceased Donor Kidneys Turned Down by A Single Center and Transplanted Elsewhere

Introduction: Sleep disorders/medication use are associated with increased risks for developing dementia in older community-dwelling adults.Older kidney transplant (KT) recipients are at increased risk for dementia, likely due to longterm kidney disease and comorbidities.Those diagnosed with a sleep disorder may be more vulnerable to developing post-KT dementia.We quantified the impact of newly-diagnosed or sleep disorders or prescribed sleep medication on diagnosed dementia risk in older patients post-KT.Methods: Using USRDS/Medicare claims data (2010-2019), we identified 14,804 (aged55 years) KT recipients with a functioning graft 1-year post-KT.Recipients with first-time sleep disorders diagnosed within 1-year post-KT and first-time diagnosis of dementia in the subsequent year were identified using ICD-9/10 codes.Newly-prescribed sedative-hypnotic medication (sleep medication) was identified using NDC codes.We used cause-specific hazard models to determine the adjusted hazard ratio (aHR) of diagnosed dementia, and incorporated inverse probability treatment of weights to address confounding by indication.Results: Between 2010-2019, 3,180 (21.5%)KT recipients were newly diagnosed with sleep disorders.Those with sleep disorders had a median age=64 years, 65.1% were White, 43.0% had a BMI30kg/m 2 , 45.5% had diabetes as the cause of kidney failure, and 11.8% had depression.Recipients with a sleep disorder diagnosis had a 42% increased risk for dementia (aHR=1.42;95%CI:1.22-1.66).Those with insomnia had a 73% increased risk for dementia (aHR=1.73;95%CI:1.29-2.31)(Table 1).7.6% of recipients were prescribed sleep medications; Zolpidem was the most prescribed (81.6%).Of those newly diagnosed with insomnia, 7.5% underwent cognitive behavioral therapy (CBT) for insomnia.Recipients prescribed any sleep medication had a 50% increased risk for dementia (aHR=1.50;95%CI:1.20-1.88);those prescribed zolpidem had a 36% increased risk (aHR=1.36;95%CI:1.07-1.74)and those prescribed doxepin had a 3.67-fold increased risk for dementia (aHR=3.67;95%CI:1.56-8.64)(Table 2).Conclusion: Older KT recipients with a newly diagnosed sleep disorder or prescribed sleep medication experience increased dementia risk; sleep disorders are modifiable risk factors that can be targeted to mitigate this risk.Sleep medication-associated dementia risk should be considered in management; CBT may be underutilized and should be considered alongside appropriate sleep medication prescription.