History of post-traumatic stress disorder and outcomes after kidney transplantation

Ashmita Siwakoti, Praveen K Potukuchi, Fridtjof Thomas, Abduzhappar Gaipov, Manish Talwar, Vasanthi Balaraman, Orsolya Cseprekal, Masahiko Yazawa, Elani Streja, James D Eason, Kamyar Kalantar-Zadeh, Csaba P Kovesdy, Miklos Z Molnar

Research output: Contribution to journalArticle

Abstract

History of posttraumatic stress disorder(PTSD), if uncontrolled, represents contraindication for kidney transplantation. However, no previous large study assessed the association between pre-transplant history of PTSD and post-transplantation outcomes. We examined 4,479 US transplanted veterans. 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 pre-transplantation PTSD and death with functioning graft, all-cause death and graft loss were examined in survival models. Post-transplant medication non-adherence was assessed using proportion of days covered(PDC). From among 4,479 veterans, 282(6.3%) had a history of PTSD. The mean±SD age of the cohort at baseline was 61±11years, 91% were male, 66% and 28% of patients were white and African-American, respectively. Compared to patients without history of PTSD, patients with a history of PTSD had similar risk of death with functioning graft[Sub-Hazard Ratio(SHR) (95%Confidence Interval(CI)):0.97(0.61-1.54)], all-cause death[Hazard Ratio(95%CI): 1.05(0.69-1.58)] and graft loss[SHR(95%CI):1.09(0.53-2.26)]. Moreover, there was no difference in immunosuppressive drug PDC in patients with and without history of PTSD (PDC:98±4% vs 99±3%,p=0.733 for tacrolimus; PDC:99±4% vs 98±7%,p=0.369 for mycophenolic acid). A history of PTSD in US veterans with end-stage renal disease, should not on its own preclude a veteran from being considered for transplantation. This article is protected by copyright. All rights reserved.

LanguageEnglish
JournalAmerican Journal of Transplantation
DOIs
Publication statusE-pub ahead of print - Jan 23 2019
Externally publishedYes

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Post-Traumatic Stress Disorders
Kidney Transplantation
Veterans
Transplants
Transplantation
Confidence Intervals
Cause of Death
Mycophenolic Acid
Medication Adherence
Tacrolimus
Immunosuppressive Agents
African Americans
Chronic Kidney Failure
Survival
Pharmaceutical Preparations

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History of post-traumatic stress disorder and outcomes after kidney transplantation. / Siwakoti, Ashmita; Potukuchi, Praveen K; Thomas, Fridtjof; Gaipov, Abduzhappar; Talwar, Manish; Balaraman, Vasanthi; Cseprekal, Orsolya; Yazawa, Masahiko; Streja, Elani; Eason, James D; Kalantar-Zadeh, Kamyar; Kovesdy, Csaba P; Molnar, Miklos Z.

In: American Journal of Transplantation, 23.01.2019.

Research output: Contribution to journalArticle

Siwakoti, A, Potukuchi, PK, Thomas, F, Gaipov, A, Talwar, M, Balaraman, V, Cseprekal, O, Yazawa, M, Streja, E, Eason, JD, Kalantar-Zadeh, K, Kovesdy, CP & Molnar, MZ 2019, 'History of post-traumatic stress disorder and outcomes after kidney transplantation', American Journal of Transplantation. https://doi.org/10.1111/ajt.15268
Siwakoti, Ashmita ; Potukuchi, Praveen K ; Thomas, Fridtjof ; Gaipov, Abduzhappar ; Talwar, Manish ; Balaraman, Vasanthi ; Cseprekal, Orsolya ; Yazawa, Masahiko ; Streja, Elani ; Eason, James D ; Kalantar-Zadeh, Kamyar ; Kovesdy, Csaba P ; Molnar, Miklos Z. / History of post-traumatic stress disorder and outcomes after kidney transplantation. In: American Journal of Transplantation. 2019.
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title = "History of post-traumatic stress disorder and outcomes after kidney transplantation",
abstract = "History of posttraumatic stress disorder(PTSD), if uncontrolled, represents contraindication for kidney transplantation. However, no previous large study assessed the association between pre-transplant history of PTSD and post-transplantation outcomes. We examined 4,479 US transplanted veterans. 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 pre-transplantation PTSD and death with functioning graft, all-cause death and graft loss were examined in survival models. Post-transplant medication non-adherence was assessed using proportion of days covered(PDC). From among 4,479 veterans, 282(6.3{\%}) had a history of PTSD. The mean±SD age of the cohort at baseline was 61±11years, 91{\%} were male, 66{\%} and 28{\%} of patients were white and African-American, respectively. Compared to patients without history of PTSD, patients with a history of PTSD had similar risk of death with functioning graft[Sub-Hazard Ratio(SHR) (95{\%}Confidence Interval(CI)):0.97(0.61-1.54)], all-cause death[Hazard Ratio(95{\%}CI): 1.05(0.69-1.58)] and graft loss[SHR(95{\%}CI):1.09(0.53-2.26)]. Moreover, there was no difference in immunosuppressive drug PDC in patients with and without history of PTSD (PDC:98±4{\%} vs 99±3{\%},p=0.733 for tacrolimus; PDC:99±4{\%} vs 98±7{\%},p=0.369 for mycophenolic acid). A history of PTSD in US veterans with end-stage renal disease, should not on its own preclude a veteran from being considered for transplantation. This article is protected by copyright. All rights reserved.",
author = "Ashmita Siwakoti and Potukuchi, {Praveen K} and Fridtjof Thomas and Abduzhappar Gaipov and Manish Talwar and Vasanthi Balaraman and Orsolya Cseprekal and Masahiko Yazawa and Elani Streja and Eason, {James D} and Kamyar Kalantar-Zadeh and Kovesdy, {Csaba P} and Molnar, {Miklos Z}",
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T1 - History of post-traumatic stress disorder and outcomes after kidney transplantation

AU - Siwakoti, Ashmita

AU - Potukuchi, Praveen K

AU - Thomas, Fridtjof

AU - Gaipov, Abduzhappar

AU - Talwar, Manish

AU - Balaraman, Vasanthi

AU - Cseprekal, Orsolya

AU - Yazawa, Masahiko

AU - Streja, Elani

AU - Eason, James D

AU - Kalantar-Zadeh, Kamyar

AU - Kovesdy, Csaba P

AU - Molnar, Miklos Z

N1 - This article is protected by copyright. All rights reserved.

PY - 2019/1/23

Y1 - 2019/1/23

N2 - History of posttraumatic stress disorder(PTSD), if uncontrolled, represents contraindication for kidney transplantation. However, no previous large study assessed the association between pre-transplant history of PTSD and post-transplantation outcomes. We examined 4,479 US transplanted veterans. 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 pre-transplantation PTSD and death with functioning graft, all-cause death and graft loss were examined in survival models. Post-transplant medication non-adherence was assessed using proportion of days covered(PDC). From among 4,479 veterans, 282(6.3%) had a history of PTSD. The mean±SD age of the cohort at baseline was 61±11years, 91% were male, 66% and 28% of patients were white and African-American, respectively. Compared to patients without history of PTSD, patients with a history of PTSD had similar risk of death with functioning graft[Sub-Hazard Ratio(SHR) (95%Confidence Interval(CI)):0.97(0.61-1.54)], all-cause death[Hazard Ratio(95%CI): 1.05(0.69-1.58)] and graft loss[SHR(95%CI):1.09(0.53-2.26)]. Moreover, there was no difference in immunosuppressive drug PDC in patients with and without history of PTSD (PDC:98±4% vs 99±3%,p=0.733 for tacrolimus; PDC:99±4% vs 98±7%,p=0.369 for mycophenolic acid). A history of PTSD in US veterans with end-stage renal disease, should not on its own preclude a veteran from being considered for transplantation. This article is protected by copyright. All rights reserved.

AB - History of posttraumatic stress disorder(PTSD), if uncontrolled, represents contraindication for kidney transplantation. However, no previous large study assessed the association between pre-transplant history of PTSD and post-transplantation outcomes. We examined 4,479 US transplanted veterans. 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 pre-transplantation PTSD and death with functioning graft, all-cause death and graft loss were examined in survival models. Post-transplant medication non-adherence was assessed using proportion of days covered(PDC). From among 4,479 veterans, 282(6.3%) had a history of PTSD. The mean±SD age of the cohort at baseline was 61±11years, 91% were male, 66% and 28% of patients were white and African-American, respectively. Compared to patients without history of PTSD, patients with a history of PTSD had similar risk of death with functioning graft[Sub-Hazard Ratio(SHR) (95%Confidence Interval(CI)):0.97(0.61-1.54)], all-cause death[Hazard Ratio(95%CI): 1.05(0.69-1.58)] and graft loss[SHR(95%CI):1.09(0.53-2.26)]. Moreover, there was no difference in immunosuppressive drug PDC in patients with and without history of PTSD (PDC:98±4% vs 99±3%,p=0.733 for tacrolimus; PDC:99±4% vs 98±7%,p=0.369 for mycophenolic acid). A history of PTSD in US veterans with end-stage renal disease, should not on its own preclude a veteran from being considered for transplantation. This article is protected by copyright. All rights reserved.

U2 - 10.1111/ajt.15268

DO - 10.1111/ajt.15268

M3 - Article

JO - American Journal of Transplantation

T2 - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6135

ER -