History of psychosis and mania, and outcomes after kidney transplantation - a retrospective study

Abstract

History of psychosis or mania, if uncontrolled, both represent relative contraindications for kidney transplantation. We examined 3680 US veterans who underwent kidney transplantation. The diagnosis of history of psychosis/mania was based on a validated algorithm. Measured confounders were used to create a propensity score-matched cohort (n = 442). Associations between pretransplantation psychosis/mania and death with functioning graft, all-cause death, graft loss, and rejection were examined in survival models and logistic regression models. Post-transplant medication nonadherence was assessed using proportion of days covered (PDC) for tacrolimus and mycophenolic acid in both groups. The mean ± SD age of the cohort at baseline was 61 ± 11 years, 92% were male, and 66% and 27% of patients were white and African-American, respectively. Compared to patients without history of psychosis/mania, patients with a history of psychosis/mania had similar risk of death with functioning graft [subhazard ratio (SHR) (95% confidence interval (CI)): 0.94(0.42-2.09)], all-cause death [hazard ratio (95% CI): 1.04 (0.51-2.14)], graft loss [SHR (95% CI): 1.07 (0.45-2.57)], and rejection [odds ratio(95% CI): 1.23(0.60-2.53)]. Moreover, there was no difference in immunosuppressive drug PDC in patients with and without history of psychosis/mania (PDC: 76 ± 21% vs. 78 ± 19%, P = 0.529 for tacrolimus; PDC: 78 ± 17% vs. 79 ± 18%, P = 0.666 for mycophenolic acid). After careful selection, pretransplantation psychosis/mania is not associated with adverse outcomes in kidney transplant recipients.

<p>Graft Loss Following Onset of Schizophrenia Long After Liver Transplantation</p>

“…Recently, two multicenter retrospective studies from France (n = 8750) 3 and the United States using USRDS (n = 3680) 4 examined the effects of a pretransplant history of psychosis (schizophrenia or bipolar disorder) on the outcome of renal transplantation. Both studies found no evidence of increased risk of medication nonadherence, rejection, or death in these patient populations.…”

“…1 Recent studies on kidney transplantation have suggested that patients with a history of psychotic disorders can do well after transplantation. [2][3][4] In contrast, information regarding new-onset psychotic disorders after organ transplantation is quite limited. Some cases have been reported mainly in the context of secondary causes, such as immunosuppressant-induced adverse effects, 5 which usually manifest postoperatively, or steroid psychosis, 6 which often occurs after steroid pulse therapy administered during episodes of rejection.…”

History of posttraumatic stress disorder and outcomes after kidney transplantation

“…7,27,[33][34][35] Figures S1-S2 shows the graphical description of the calculations for different adherence methods. Proportion of days covered (PDC) and medication persistence were calculated.…”

“…[5][6][7] Multiple guidelines list active psychiatric illness as an absolute contraindication without a very clear definition of what constitutes an active psychiatric illness. [5][6][7] Multiple guidelines list active psychiatric illness as an absolute contraindication without a very clear definition of what constitutes an active psychiatric illness.…”

“…Transplant programs commonly include some form of assessment of mental health problems, but there is a lack of consensus on both how best to assess mental health and what constitutes an absolute contraindication to transplantation. [5][6][7] Multiple guidelines list active psychiatric illness as an absolute contraindication without a very clear definition of what constitutes an active psychiatric illness.…”