Psychiatric Profile of Patients Currently Listed for Kidney Transplantation: Evidence of the Need for More Thorough Pretransplant Psychiatric Evaluations

Jesse, Michelle T; Eshelman, Anne; Christian, Teresa; Abouljoud, Marwan; Denny, Jason E; Patel, Anita; Kim, Dean

doi:10.1016/j.transproceed.2019.08.035

Cited by 7 publications

(13 citation statements)

References 44 publications

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“…There is high prevalence of cognitive impairment and psychiatric and substance use disorders among potential candidates as well as among those on the transplant wait list. 13 It is critical to adequately stabilize mood disorders pretransplant, particularly depression, given its association with inferior posttransplant outcomes. 14 Evidence, however, is mixed for the association between social support and poor outcomes following transplantation.…”

Section: Clinical Utilitymentioning

confidence: 99%

KDOQI US Commentary on the 2020 KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation

Puttarajappa

Schinstock

et al. 2021

American Journal of Kidney Diseases

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Evaluation of patients for kidney transplant candidacy is a comprehensive process that involves a detailed assessment of medical and surgical issues, psychosocial factors, and patients' physical and cognitive abilities with an aim of balancing the benefits of transplantation and potential risks of surgery and long-term immunosuppression. There is considerable variability among transplant centers in their approach to evaluation and decision-making regarding transplant candidacy. The 2020 KDIGO (Kidney Disease: Improving Guidelines Outcome) clinical practice guideline on the evaluation and management of candidates for kidney transplantation provides practice recommendations that can serve as a useful reference guide to transplant professionals. The guideline, covering a broad range of topics, was developed by an international group of experts from transplant and nephrology through a review of literature published until May 2019. A work group of US transplant nephrologists convened by NKF-KDOQI (National Kidney Foundation-Kidney Disease Quality Initiative) chose key topics for this commentary with a goal of presenting a broad discussion to the US transplant community. Each section of this article has a summary of the key KDIGO guideline recommendations, followed by a brief commentary on the recommendations, their clinical utility, and potential implementation challenges. The KDOQI work group agrees broadly with the KDIGO recommendations but also recognizes and highlights the decision-making challenges that arise from lack of high-quality evidence and the need to balance equity with utility of organ transplantation.Because they are designed to reflect the views and recommendations of the responsible KDOQI Commentary work group and they are reviewed and approved by KDOQI and NKF leadership, KDOQI Commentaries are not peer reviewed by AJKD. This article was prepared by a KDOQI Commentary work group comprising the authors and chaired by Dr Sundaram Hariharan. It was reviewed and approved by the NKF Scientific Advisory Board and the KDOQI Chair and Vice Chairs.Complete author and article information provided before references.

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Section: Clinical Utilitymentioning

confidence: 99%

KDOQI US Commentary on the 2020 KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation

Puttarajappa

Schinstock

et al. 2021

American Journal of Kidney Diseases

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“…Mental health and psychosocial issues are common among renal failure and kidney transplant candidates and are associated with short and long-term outcomes. [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.…”

Section: Introductionmentioning

confidence: 99%

“…[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.…”

Section: Introductionmentioning

confidence: 99%

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

Manay

Eyck

Siniff

et al. 2021

Clinical Transplantation

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Background:The effect of psychosocial problems on listing outcomes and potential interactions with functional metrics is not well-characterized among Veteran transplant candidates. Methods:The results from psychosocial evaluations, frailty metrics, and biochemical markers were collected on 375 consecutive Veteran kidney transplant candidates. Psychosocial diagnoses were compared between patients listed or denied for transplant.Functional abilities were compared among patients with or without psychosocial diagnoses and then evaluated based on reason for denial.Results: Eighty-four percent of patients had a psychosocial diagnosis. Common issues included substance or alcohol abuse (62%), psychiatric diagnoses (50%), and poor adherence (25%). Patients with psychiatric diagnoses, cognitive impairments, and poor adherence were more likely to be denied for transplant (P < .05). Patients with depression, PTSD, and anxiety did not have worse functional ability, but experienced more exhaustion than patients without these problems. Patients denied for medical but not purely psychosocial reasons had worse troponin and functional metrics compared with listed patients. Conclusion:Over 80% of patients with a psychosocial diagnosis were listed; however, poor adherence was a particularly important reason for denial for purely psychosocial reasons. Patients with psychosocial diagnoses generally were not more functionally limited than their counterparts without psychosocial diagnoses or those listed for transplant.

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“…17 Given the increased prevalence of marijuana use and legalization, the transplant community is currently faced with more difficult decisions on service provision. [18][19][20][21] Literature about marijuana use and transplant outcomes is limited. Some studies have suggested poor outcomes in patients using marijuana, primarily due to medical nonadherence and the risk of opportunistic infections.…”

Section: Introductionmentioning

confidence: 99%

“…Given the increased prevalence of marijuana use and legalization, the transplant community is currently faced with more difficult decisions on service provision 18‐21 . Literature about marijuana use and transplant outcomes is limited.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of cannabis use and associated outcomes among kidney transplant recipients: A meta‐analysis

Vaitla

Hansrivijit

Kanduri

et al. 2020

J Evidence Based Medicine

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Objective: Cannabis is the most commonly used recreational drug in the United States, and transplant acceptability for cannabis using candidates varies among transplant centers. However, the prevalence and impact of cannabis use on outcomes of kidney transplant recipients remain unclear. This study aimed to summarize the prevalence and impact of cannabis use on outcomes after kidney transplantation.Methods: A literature search was performed using Ovid MEDLINE, EMBASE, and The Cochrane Library Databases from inception until September 2019 to identify studies assessing the prevalence of cannabis use among kidney transplant recipients, and reported adverse outcomes after kidney transplantation. Effect estimates from the individual studies were obtained and combined utilizing random-effects, generic inverse variance method of DerSimonian-Laird.Results: A total of four cohort studies with a total of 55 897 kidney transplant recipients were enrolled. Overall, the pooled estimated prevalence of cannabis use was 3.2% (95% CI 0.4%-20.5%). While the use of cannabis was not significantly associated with all-cause allograft failure (OR = 1.31, 95% CI 0.70-2.46) or mortality (OR = 1.52, 95% CI 0.59-3.92), the use of cannabis among kidney transplant recipients was significantly associated with increased death-censored graft failure with pooled OR of 1.72 (95% CI 1.13-2.60). Conclusions:The overall estimated prevalence of cannabis use among kidney transplant recipients is 3.2%. The use of cannabis is associated with increased deathcensored graft failure, but not mortality after kidney transplantation.

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Psychiatric Profile of Patients Currently Listed for Kidney Transplantation: Evidence of the Need for More Thorough Pretransplant Psychiatric Evaluations

Cited by 7 publications

References 44 publications

KDOQI US Commentary on the 2020 KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation

KDOQI US Commentary on the 2020 KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation

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

Epidemiology of cannabis use and associated outcomes among kidney transplant recipients: A meta‐analysis

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