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

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


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
Issue number5
Publication statusPublished - 2018


  • 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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