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 language | English |
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Pages (from-to) | 554-565 |
Number of pages | 12 |
Journal | Transplant International |
Volume | 31 |
Issue number | 5 |
DOIs | |
Publication status | Published - 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