Brain white matter microstructure as a predictor of fatigue progression in kidney transplant recipients

Motivation: Fatigue affects over half of kidney transplant recipients (KTRs), investigating white matter (WM) microstructure in KTRs could guide targeted interventions. Goal(s): This study aims to identify WM microstructural characteristics in KTRs, their contribution to fatigue, and relevant renal function indicators, while assessing their predictive role in post-COVID-19 fatigue development. Approach: We used DKI-based tract-based spatial statistics to compare WM microstructure between KTRs and HCs, examining its relationship with renal function and fatigue. Results: KTRs showed reduced microstructural complexity in the right cingulum hippocampus tract compared to HCs, a predictor of both current and post-COVID-19 fatigue, with urea levels significantly impacting this association. Impact: This study suggests that WM complexity may be a biomarker for fatigue progression in KTRs, potentially linking renal function to neuropsychiatric symptoms. These findings offer insights into mechanisms underlying fatigue in KTRs and point to possible therapeutic targets.