Background Frail kidney transplant (KT) recipients may be particularly vulnerable to surgical stressors, resulting in delirium and subsequent adverse outcomes. We sought to identify the incidence, risk factors, and sequelae of post-KT delirium.

Methods We studied 125,304 adult KT recipients (1999–2014) to estimate delirium incidence in national registry claims. Additionally, we used a validated chart abstraction algorithm to identify post-KT delirium in 893 adult recipients (2009–2017) from a cohort study of frailty. Delirium sequelae were identified using adjusted logistic regression (length of stay ≥2 weeks and institutional discharge [skilled nursing or rehabilitation facility]) and adjusted Cox regression (death-censored graft loss and mortality).

Results Only 0.8% of KT recipients had a delirium claim. In the cohort study, delirium incidence increased with age (18–49 years old: 2.0%; 50–64 years old: 4.6%; 65–75 years old: 9.2%; and ≥75 years old: 13.8%) and frailty (9.0% versus 3.9%); 20.0% of frail recipients aged ≥75 years old experienced delirium. Frailty was independently associated with delirium (odds ratio [OR], 2.05; 95% confidence interval [95% CI], 1.02 to 4.13; P=0.04), but premorbid global cognitive function was not. Recipients with delirium had increased risks of ≥2-week length of stay (OR, 5.42; 95% CI, 2.76 to 10.66; P<0.001), institutional discharge (OR, 22.41; 95% CI, 7.85 to 63.98; P<0.001), graft loss (hazard ratio [HR], 2.73; 95% CI, 1.14 to 6.53; P=0.03), and mortality (HR, 3.12; 95% CI, 1.76 to 5.54; P<0.001).

Conclusions Post-KT delirium is a strong risk factor for subsequent adverse outcomes, yet it is a clinical entity that is often missed.

背景体弱的肾脏移植（KT）受者可能特别容易受到外科手术的压力，导致ir妄及随后的不良后果。我们试图确定KT后ir妄的发生率，危险因素和后遗症。

方法我们研究了125304名成年KT接受者（1999-2014年），以估算国家注册管理机构声明中的ir妄发生率。此外，我们使用了一项经过验证的图表抽象算法，从一项脆弱性队列研究中确定了893名成人接受者（2009-2017年）的KT后del妄。使用调整后的逻辑回归（住院时间≥2周和机构出院[专业护理或康复设施]）和调整后的Cox回归（死亡检查的移植物损失和死亡率）确定妄后遗症。

结果只有0.8％的KT接受者有del妄要求。在队列研究中，del妄发生率随年龄和体弱（18-49岁：2.0％； 50-64岁：4.6％； 65-75岁：9.2％；≥75岁：13.8％）而增加。 9.0％和3.9％）；年龄≥75岁的脆弱接受者中有20.0％发生del妄。rail弱与del妄独立相关（优势比[OR]为2.05； 95％置信区间[95％CI]为1.02至4.13；P = 0.04），但病态前的整体认知功能却没有。患有ir妄的患者住院两周以上的风险增加（OR，5.42; 95％CI，2.76至10.66; P <0.001），机构出院（OR，22.41; 95％CI，7.85至63.98; P <0.001 ），移植物损失（危险比[HR]为2.73； 95％CI为1.14至6.53；P= 0.03）和死亡率（HR，3.12； 95％CI，1.76至5.54；P <0.001）。

结论KT后ir妄是随后发生不良后果的重要危险因素，但它却经常被遗漏。