Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, USA.
Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
Transpl Int. 2018 May;31(5):554-565. doi: 10.1111/tri.13127. Epub 2018 Feb 27.
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.
如果未得到控制，精神病或躁狂病史均代表肾移植的相对禁忌症。我们检查了 3680 名接受肾移植的美国退伍军人。精神病/躁狂病史的诊断基于经过验证的算法。使用测量的混杂因素创建了倾向评分匹配队列（n=442）。在生存模型和逻辑回归模型中，检查了移植前精神病/躁狂与功能移植物存活、全因死亡、移植物丢失和排斥之间的关联。在两组中，使用他克莫司和吗替麦考酚酸的覆盖天数（PDC）评估移植后药物不依从性。队列的基线平均年龄±标准差为 61±11 岁，92%为男性，分别有 66%和 27%的患者为白人和非裔美国人。与无精神病/躁狂病史的患者相比，有精神病/躁狂病史的患者的功能移植物存活、全因死亡、移植物丢失和排斥的风险相似[亚危险比（SHR）（95%置信区间（CI））：0.94（0.42-2.09）]、全因死亡[风险比（95% CI）：1.04（0.51-2.14）]、移植物丢失[SHR（95% CI）：1.07（0.45-2.57）]和排斥[比值比（95% CI）：1.23（0.60-2.53）]。此外，有和无精神病/躁狂病史的患者的免疫抑制药物 PDC 无差异（PDC：76±21%比 78±19%，他克莫司 P=0.529；PDC：78±17%比 79±18%，吗替麦考酚酸 P=0.666）。经过仔细选择，移植前精神病/躁狂与肾移植受者的不良结局无关。
