Open AccessHistory of psychosis and mania, and outcomes after kidney transplantation ‐ a retrospective study
Author(s) -
Molnar Miklos Z.,
Eason James D.,
Gaipov Abduzhappar,
Talwar Manish,
Potukuchi Praveen K.,
Joglekar Kiran,
Remport Adam,
Mathe Zoltan,
Mucsi Istvan,
Novak Marta,
KalantarZadeh Kamyar,
Kovesdy Csaba P.
Publication year - 2018
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13127
Subject(s) - medicine , mania , hazard ratio , transplantation , kidney transplantation , psychosis , odds ratio , tacrolimus , cohort , retrospective cohort study , psychiatry , confidence interval , bipolar disorder , lithium (medication)
Summary 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.