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

M.Z. Molnar, J.D. Eason, A. Gaipov, M. Talwar, P.K. Potukuchi, K. Joglekar, A. Remport, Z. Mathe, I. Mucsi, M. Novak, K. Kalantar-Zadeh, C.P. Kovesdy

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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. © 2018 Steunstichting ESOT
Original languageEnglish
Pages (from-to)554-565
Number of pages12
JournalTransplant International
Volume31
Issue number5
DOIs
Publication statusPublished - 2018

Keywords

  • mycophenolic acid
  • tacrolimus, adult
  • African American
  • age distribution
  • all cause mortality
  • Article
  • Caucasian
  • controlled study
  • disease association
  • female
  • graft failure
  • graft rejection
  • human
  • kidney transplantation
  • major clinical study
  • male
  • mania
  • medication compliance
  • priority journal
  • psychosis
  • risk assessment
  • risk factor
  • sex difference
  • treatment outcome
  • veteran
  • aged
  • bipolar disorder
  • cause of death
  • complication
  • middle aged
  • mortality
  • retrospective study, Aged
  • Bipolar Disorder
  • Cause of Death
  • Female
  • Graft Rejection
  • Humans
  • Kidney Transplantation
  • Male
  • Medication Adherence
  • Middle Aged
  • Psychotic Disorders
  • Retrospective Studies

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    Molnar, M. Z., Eason, J. D., Gaipov, A., Talwar, M., Potukuchi, P. K., Joglekar, K., Remport, A., Mathe, Z., Mucsi, I., Novak, M., Kalantar-Zadeh, K., & Kovesdy, C. P. (2018). History of psychosis and mania, and outcomes after kidney transplantation - a retrospective study. Transplant International, 31(5), 554-565. https://doi.org/10.1111/tri.13127