Posttransplantation Outcomes in Veterans With Serious Mental Illness

Evans, Lianna D.; Stock, Eileen M.; Zeber, John E.; Morissette, Sandra B.; MacCarthy, Andrea A.; Sako, Edward Y.; Lappin, Jacqueline; Lawrence, Valerie A.; MacCarthy, Daniel; Copeland, Laurel A.

doi:10.1097/tp.0000000000000616

Cited by 27 publications

(17 citation statements)

References 30 publications

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“…23,[38][39][40] More recent studies performed in US veterans showed no worse posttransplant outcomes in solid organ transplant patients who had pretransplant serious mental health disorders and in kidney transplant recipients with pretransplant psychosis or mania. 7,25 These results are consistent with our present findings in PTSD patients, which also show that patients with pretransplant PTSD had comparable degrees of medication adherence compared to patients without pretransplant PTSD. Previous studies have shown medication noncompliance to be a major risk factor for graft rejection and poor outcomes posttransplant.…”

Section: Discussionsupporting

confidence: 91%

“…In addition, the majority of transplant programs consider a history of psychosocial conditions such as PTSD a relative or absolute contraindication for transplantation. 24,25 Consequently, the association between a history of PTSD pretransplantation and graft and patient outcomes posttransplantation is still uncertain. Previous studies have shown that posttransplant PTSD was associated with worse physical-and mental health-related quality of life, 23 whereas the association between presence of PTSD and medication adherence is conflicting.…”

Section: Introductionmentioning

confidence: 99%

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History of posttraumatic stress disorder and outcomes after kidney transplantation

Siwakoti

Potukuchi

Thomas

et al. 2019

American Journal of Transplantation

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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.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

History of posttraumatic stress disorder and outcomes after kidney transplantation

Siwakoti

Potukuchi

Thomas

et al. 2019

American Journal of Transplantation

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“…These observational studies have shown the feasibility of transplantation in patients with history of psychiatric disorders with an excellent patient and allograft survival rate. One of the largest studies examined 164 veteran organ transplant recipients (40 with a kidney graft) and reported excellent outcomes in the first 3 years after transplantation . Similar results were reported from the Irish National Renal Transplant Programme .…”

Section: Introductionmentioning

confidence: 98%

“…Published data on post‐transplant outcomes in patients with history of pretransplant history of psychosis/mania are extremely limited and consists mainly of case reports and very small observational studies . These observational studies have shown the feasibility of transplantation in patients with history of psychiatric disorders with an excellent patient and allograft survival rate. One of the largest studies examined 164 veteran organ transplant recipients (40 with a kidney graft) and reported excellent outcomes in the first 3 years after transplantation .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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.

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“…al analyzed health services data for 822 solid organ transplants in the national Veteran Administration system and found that 17% of transplant recipients suffered from SMI, while 30% carried other mental health diagnoses. The study found no difference in attendance at follow-up appointments, frequency of filling immunosuppressant prescriptions, or 3-year mortality among those with SMI, another mental health diagnosis, or no mental health diagnosis(2). Similarly, Price et al's recent review found no evidence of poorer post-transplant adherence in patients with psychotic disorders than in patients without(1).…”

Section: Mood and Psychotic Disordersmentioning

confidence: 87%

Psychiatric aspects of organ transplantation and donation

Faeder¹,

Moschenross²,

Rosenberger³

et al. 2015

Current Opinion in Psychiatry

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Purpose of the review Psychiatrists and other mental health professionals typically assist with evaluating and treating psychiatric and behavioral issues in transplant candidates, recipients and living organ donors. In this review recent findings on specific psychiatric issues in adult solid organ transplant candidates and recipients, as well as living donors are discussed as well as their relevance to clinical practice. Recent findings Patients with complex mental health and addiction histories can have outcomes similar to patients without these disorders but may require specialized pre-transplant preparation or post-transplant interventions to optimize their outcomes. Specific attention to the preparation and wellbeing of living donors is needed. Summary As transplant programs increasingly consider patients with complex mental health histories, psychiatrists and mental health professionals evaluating and treating these patients need to consider plans for early identification and treatment. Psychiatric care provided across the pre- to post-operative periods will best address the longitudinal care needs of patients with mental health disorders. Abstinence from substances and complete adherence to medical directives provides the best chance for optimal outcomes. Treatment of depression may improve transplant outcomes. Research is needed to identify effective interventions and the best strategies to engage patients to improve adherence.

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Posttransplantation Outcomes in Veterans With Serious Mental Illness

Abstract: Serious mental illness diagnosis does not appear to be associated with adverse transplantation outcomes over the first 3 years; however, a potentially diverging survival curve may portend higher mortality at 5 years.

Cited by 27 publications

References 30 publications

History of posttraumatic stress disorder and outcomes after kidney transplantation

History of posttraumatic stress disorder and outcomes after kidney transplantation

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

Psychiatric aspects of organ transplantation and donation

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