Outcomes of Renal Transplantation in Patients With Bipolar Affective Disorder and Schizophrenia: A National Retrospective Cohort Study

Butler, Mary I.; McCartan, Deirdre; Cooney, Anne; Kelly, P; Ahmed, Izhar; Little, Dilly; MacHale, Siobhan; Conlon, Peter J.

doi:10.1016/j.psym.2016.08.010

Cited by 20 publications

(20 citation statements)

References 31 publications

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“…Similar results were reported from the Irish National Renal Transplant Programme . Comparing 15 patients with diagnosis of bipolar affective disorder and six patients with schizophrenia with the rest of the recipients, there were no significant differences in patient survival, graft survival, and graft function . Well‐known risk factors of allograft loss were antisocial behavior, associated depression, medical noncompliance, history of psychotic episodes more than 1 year before transplantation, homelessness, and isolation .…”

Section: Introductionsupporting

confidence: 78%

“…One of the largest studies examined 164 veteran organ transplant recipients (40 with a kidney graft) and reported excellent outcomes in the first 3 years after transplantation . Similar results were reported from the Irish National Renal Transplant Programme . Comparing 15 patients with diagnosis of bipolar affective disorder and six patients with schizophrenia with the rest of the recipients, there were no significant differences in patient survival, graft survival, and graft function .…”

Section: Introductionsupporting

confidence: 57%

“…Psychiatric disorders, especially a history of psychosis and/or mania, which are the cardinal symptoms of schizophrenia and bipolar disorder, remain a relative contraindication endorsed by most organ transplant societies . There are several reasons for this, including concerns about relapse of psychiatric illness, medication and other post‐transplant treatment adherence, inadequate social support, emotional and cognitive capability, and potential drug interactions between psychotropic and immunosuppressant medications . However, there are very few data to support these concerns and most of them stem from assessment during the post‐transplant period .…”

Section: Introductionmentioning

confidence: 99%

“…Published data on post‐transplant outcomes in patients with history of pretransplant history of psychosis/mania are extremely limited and consists mainly of case reports and very small observational studies . These observational studies have shown the feasibility of transplantation in patients with history of psychiatric disorders with an excellent patient and allograft survival rate. One of the largest studies examined 164 veteran organ transplant recipients (40 with a kidney graft) and reported excellent outcomes in the first 3 years after transplantation .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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.

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Section: Introductionsupporting

confidence: 78%

Section: Introductionsupporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“… 13 Data regarding the risks of psychosis or mania in KT recipients are conflicting. 14 - 16 Few guidelines exist on the evaluation and management of new-onset psychiatric diseases after transplantation. Our case highlights the diagnostic challenges this presentation raises and summarizes management considerations.…”

Section: Discussionmentioning

confidence: 99%

New-onset Psychosis in an Immunosuppressed Patient With Kidney Transplantation: An Educational Case Report

Mappin‐Kasirer

Hoffman

Sandal

2020

Can J Kidney Health Dis

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Rationale: New-onset psychosis in an immunosuppressed patient post-kidney transplantation (KT) is a diagnostic challenge. A broad differential diagnosis merits consideration; however, an approach to this differential diagnosis remains to be outlined in the literature. Also, when and how to modify the maintenance immunosuppressive regimen remains a significant area of controversy. Presenting concerns: A 23-year-old male, known for X-linked Alport syndrome for which he had undergone KT 1 year prior, presented with a 1-week history of disorganized speech, bizarre behavior, religious delusions, and visual hallucinations. Diagnoses: After ruling out infectious, metabolic, autoimmune, and structural causes, immunosuppressant medications were changed from tacrolimus to cyclosporine. The patient did not improve after this change, and a second opinion consultation with a transplant psychiatrist led to a diagnosis of primary first-episode psychosis, later refined to bipolar disorder type I. Interventions: The patient was started on risperidone, which led to a significant improvement in his symptoms. Outcomes: Twelve months after discharge, his mood and behavior had returned to baseline on aripiprazole, bupropion, and citalopram. However, he developed acute allograft rejection, prompting a change from cyclosporine back to tacrolimus, with stability of his mental state and graft function. Teaching points: This report offers learners an extensive and organized differential diagnosis to the work up of psychosis post kidney transplantation. A complete history, with input from collateral sources, and a systematic approach to the differential diagnosis, are crucial and should not be overshadowed by the risk of immunosuppressant-related neurotoxicity. We underscore the importance of multi-disciplinary management and comprehensive psychosocial assessment and re-assessment to refine the diagnosis. We also report the successful re-introduction of tacrolimus once the diagnosis of a primary psychiatric disorder is confirmed. Finally, we offer a simplified approach that can aid in distinguishing between a primary psychiatric diagnosis versus tacrolimus-associated psychosis.

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Mood Disorders in Transplantation: Bipolar Disorder Spectrum

Dahal

Zimbrean²

2022

Transplant Psychiatry

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Outcomes of Renal Transplantation in Patients With Bipolar Affective Disorder and Schizophrenia: A National Retrospective Cohort Study

Cited by 20 publications

References 31 publications

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

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

New-onset Psychosis in an Immunosuppressed Patient With Kidney Transplantation: An Educational Case Report

Mood Disorders in Transplantation: Bipolar Disorder Spectrum

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