History of posttraumatic stress disorder and outcomes after kidney transplantation

Abstract

A history of posttraumatic stress disorder (PTSD), if uncontrolled, represents a contraindication for kidney transplantation. However, no previous large study has assessed the association between pretransplant history of PTSD and posttransplantation outcomes. We examined 4479 US veterans who had undergone transplantation. The diagnosis of history of PTSD was based on a validated algorithm. Measured covariates were used to create a matched cohort (n = 560). Associations between pretransplant PTSD and death with functioning graft, all-cause death, and graft loss were examined in survival models. Posttransplant medication nonadherence was assessed using proportion of days covered (PDC). From among 4479 veterans, 282 (6.3%) had a history of PTSD. The mean age ± standard deviation (SD) of the cohort at baseline was 61 ± 11 years, 91% were male, and 66% and 28% of patients were white and African American, respectively. Compared to patients without a history of PTSD, patients with a history of PTSD had a similar risk of death with a functioning graft (subhazard ratio [SHR] 0.97, 95% confidence interval [CI] 0.61-1.54), all-cause death (1.05, 0.69-1.58), and graft loss (1.09, 0.53-2.26). Moreover, there was no difference in | 2295 SIWAKOTI eT Al.

Post-Traumatic Stress Disorder and Post-Traumatic Growth following Kidney Transplantation

“…Six included pediatric populations (7,18 –20,25,26). There were four literature reviews (5,7,23,25) and two retrospective chart reviews (17,18). Six studies collected cross-sectional data from KT recipients (4,16,19,20,22,26), two studies collected longitudinal data from KT candidates and recipients of living related donor organs (14,24), one study collected longitudinal data from KT recipients (15), and one described an RCT of expressive writing (21).…”

“…Since symptoms of PTSD present differently across developmental stages, diagnostic criteria for PTSD are different for children under six years old (9), thus limiting comparability across pediatric studies to adult patients (7). While prior trauma exposure (with no known PTSD diagnosis) increased risk for PTSD post-KT (4), a previous PTSD diagnosis did not impact death, graft loss, or medication nonadherence risk post-KT (17), possibly highlighting the negative impact of undiagnosed mental illness. PTSD post-KT was associated with increased prevalence of other psychiatric co-morbidities and poorer QOL and sleep (4,7,16,20).…”

“…Although prior trauma exposure (with no known PTSD diagnosis) increased risk for PTSD post KT (4), a previous PTSD diagnosis did not affect death, graft loss, or medication nonadherence risk post KT (17), possibly highlighting the negative effect of undiagnosed mental illness. PTSD post KT was associated with increased prevalence of other psychiatric comorbidities and poorer QOL and sleep (4,7,16,20).…”

Association between Posttransplant Opioid Use and Immunosuppressant Therapy Adherence among Renal Transplant Recipients

“…The association of opioid exposure (yes vs. no) and AMME dose with tacrolimus adherence within the first year of transplant was examined using logistic regression in unadjusted and adjusted analyses. The following potential confounders were included in the multivariable-adjusted models based on theoretical considerations in accordance with previous results from the literature [34] For IPTW analyses, we used logistic regression to calculate propensity scores based on all demographic and comorbidity variables, which were then used directly as stabilized inverse weights to estimate average treatment effects. In order to handle extreme weights, we used stabilized weights, which have a mean weight close to 1 and maximum weight less than 10 [35].…”

Psychosocial characteristics of patients evaluated for kidney transplant and associations with functional and frailty metrics at a veterans affairs hospital

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14] Therefore, these issues are considered in the transplant evaluation process. 15,16 While pretransplant mental health evaluation methods are variable across the United States, 13,14,17 to accommodate the high rate of mental health issues among Veterans, [18][19][20] the VA kidney transplant evaluation process was developed to include both a social work and psychological evaluation for each candidate prior to an onsite evaluation. 21,22 Frailty, also common among transplant patients, 23 is known to be associated with transplant outcomes including length of stay, 24 readmission, 25 delayed graft function and mortality 24,[26][27][28] and has been increasingly incorporated into the candidate selection process.…”