Background: Cognitive impairment is increasingly recognized as a clinically relevant outcome in transplant medicine. We compared multidomain cognitive performance between kidney transplant (KTx) and liver transplant (LTx) recipients and explored etiology-specific differences within the LTx cohort using a standardized cognitive assessment. Methods: This single-center cross-sectional study included 180 adult transplant recipients, 90 KTx and 90 LTx recipients, stratified into alcohol-associated liver disease (ALD; n = 25) and non-ALD etiologies (n = 65). Cognitive performance was assessed using Addenbrooke’s Cognitive Examination III (ACE-III). Median time since transplantation was 3.3 months in KTx recipients, 69.2 months in non-ALD LTx recipients, and 17.2 months in ALD LTx recipients. Group differences were analyzed using nonparametric tests with Holm correction, and independent predictors of global cognition were evaluated using multivariable linear regression adjusted for age, education, and time since transplantation. Results: Global cognitive performance differed modestly across groups, with mean ACE-III scores of 90.3 ± 8.7 in KTx, 89.3 ± 6.5 in non-ALD LTx, and 86.9 ± 12.5 in ALD LTx recipients (overall p = 0.047), although no pairwise differences remained significant after Holm correction. However, the relatively small ALD subgroup may have limited statistical power and may have led to underestimation of clinically relevant between-group differences. ACE-III scores ≤ 89 occurred in 30.0%, 47.7%, and 48.0% of participants, respectively, whereas scores < 82 were observed in 13.3%, 12.3%, and 20.0%. Verbal fluency was the lowest-performing domain across groups. Higher education and younger age independently predicted better cognitive performance; time since transplantation was not independently associated with cognitive outcome. Conclusions: Cognitive performance appeared broadly comparable across KTx and LTx recipients, but this finding should be interpreted cautiously given differences in post-transplant follow-up and potential residual confounding. Clinically relevant cognitive vulnerability was common across all groups, supporting structured multidomain assessment and longitudinal studies using harmonized methods.
Miarka et al. (2026) studied this question.