Hospitalized Psychoses after Renal Transplantation in the United States

Abstract

ABSTRACT. Although it is recommended that renal transplant (RT) candidates routinely undergo screening for mental health–related conditions, national statistics for psychoses after RT have not been reported. This is a historical cohort study of 39,628 renal transplant recipients in the United States Renal Data System between July 1, 1994, and June 30, 1998, and followed until December 31, 1999. Adjusted hazard ratios (AHR) for time to hospitalization for both a primary and secondary discharge diagnosis of psychoses (ICD-9 codes 290.x-299.x) after RT and mortality/graft loss after psychosis were assessed by Cox Regression. In addition, rates of psychosis were compared with 178,986 patients with Medicare as their primary payer who started chronic dialysis from April 1, 1995, to June 29, 1999. The incidence of psychoses was 7.5/1000 person-years (PY) after RT compared with 7.2/1000 PY for all patients on chronic dialysis and 9.6/1000 PY for dialysis patients aged 65 yr or younger. Among RT recipients, graft loss (AHR, 2.97; 95% CI, 2.19 to 4.02), allograft rejection, and cadaveric donation were independently associated with psychosis, which was associated with an increased risk of both death (AHR, 2.09; 95% CI, 1.71 to 2.56; P < 0.001) and graft loss (AHR, 1.79; 95% CI, 1.15 to 2.78; P = 0.01). Graft loss due to noncompliance was significantly more common after psychosis (9.0% versus 3.7% in patients not hospitalized for psychosis; P < 0.001). The incidence of hospitalized psychosis was not substantially higher after RT compared with chronic dialysis patients. Psychoses were independently associated with increased risk of death and graft loss after renal transplantation, possibly mediated through medical non-adherence. E-mail: kevin.abbott@na.amedd.army.mil

Organiczne zaburzenia urojeniowe u pacjentki po przeszczepie nerki – opis przypadku

“…Badania częstości występowania zaburzeń psychicznych wykazały, iż jest ona większa u pacjentów przewlekle dializowanych niż w populacji ogólnej. Psychoza pojawiająca się po przeszczepie nerki była dość rzadko opisywana w czasopismach medycznych, istnieją jednak doniesienia, iż przeszczep nerki może predysponować pacjentów do zwiększonego ryzyka zachorowania na choroby psychiczne, w szczególno-ści zaburzenia psychotyczne [15]. Ważną rolę przypisuje się w tych przypadkach lekom immunosupresyjnym używanym w transplantologii, do których zalicza się inhibitory kalcyneuryny, które mogą dawać neuropsychologiczne efekty uboczne w formie zaburzeń psychotycznych.…”

Neurological complications of solid organ transplantation

“…The occurrence of hospitalized psychoses has independently been associated with increased risk of death and graft loss after renal transplantation, possibly mediated through medical non-adherence 34 …”

“…Excessive sedation may occur in patients with severe hepatic or renal failure and the elderly. Brain imaging, EEG, and lumbar puncture may provide important information 34 .…”

“…In addition, several conditions predispose transplanted patients to an increased risk of psychosis: the use of high-dose corticosteroids, chronic illness-associated affective disorders, metabolic disturbances, and other immunosuppressive medications used in transplantation, such as calcineurin inhibitors, which have known neuropsychological side effects 34 . Emergency psychiatric consultation is indicated when psychotic symptoms interfere with medical management or are associated with suicidal ideation.…”

“…Emergency psychiatric consultation is indicated when psychotic symptoms interfere with medical management or are associated with suicidal ideation. The effectiveness of pharmacologic management has improved with the availability of newer atypical antipsychotic agents 34 .…”