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History of posttraumatic stress disorder and outcomes after kidney transplantation
Author(s) -
Siwakoti Ashmita,
Potukuchi Praveen K.,
Thomas Fridtjof,
Gaipov Abduzhappar,
Talwar Manish,
Balaraman Vasanthi,
Cseprekal Orsolya,
Yazawa Masahiko,
Streja Elani,
Eason James D.,
KalantarZadeh Kamyar,
Kovesdy Csaba P.,
Molnar Miklos Z.
Publication year - 2019
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15268
Subject(s) - medicine , contraindication , transplantation , kidney transplantation , cohort , mycophenolic acid , confidence interval , psychiatric history , surgery , psychiatry , pathology , alternative medicine , epilepsy
A history of posttraumatic stress disorder (PTSD), if uncontrolled, represents a contraindication for kidney transplantation. However, no previous large study has assessed the association between pretransplant history of PTSD and posttransplantation outcomes. We examined 4479 US veterans who had undergone transplantation. 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 pretransplant PTSD and death with functioning graft, all‐cause death, and graft loss were examined in survival models. Posttransplant medication nonadherence was assessed using proportion of days covered (PDC). From among 4479 veterans, 282 (6.3%) had a history of PTSD. The mean age ± standard deviation (SD) of the cohort at baseline was 61 ± 11 years, 91% were male, and 66% and 28% of patients were white and African American, respectively. Compared to patients without a history of PTSD, patients with a history of PTSD had a similar risk of death with a functioning graft (subhazard ratio [SHR] 0.97, 95% confidence interval [CI] 0.61‐1.54), all‐cause death (1.05, 0.69‐1.58), and graft loss (1.09, 0.53‐2.26). Moreover, there was no difference in immunosuppressive drug PDC in patients with and without a history of PTSD (PDC: 98 ± 4% vs 99 ± 3%, P = .733 for tacrolimus; PDC: 99 ± 4% vs 98 ± 7%, P = .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.