Psychiatric and medical adverse events for kidney transplant recipients with lithium induced kidney disease

Abstract

Background: The purpose of this study is to describe post-transplant psychiatric and medical adverse events for kidney transplant (KT) recipients with a history of lithium induced kidney disease. According to the United Network for Organ Sharing (UNOS) as of January 2015 there have been 208 kidney transplantations done in the USA for this condition and 227 are currently waiting for a kidney. Considering the evidence that decompensated psychiatric conditionsmay interferewith post-transplant outcomes, there is a concern about the risk of posttransplant adverse events in this population. To our knowledge, at this time there is no information about medical or psychiatric course post transplantation for kidney recipients with a history of lithium toxicity. Method: Retrospective study of patients who received kidney transplantation for lithium induced kidney disease at Yale Transplantation Center. The following electronic documents were reviewed: discharge summaries, admission assessments, clinic visit notes, social work evaluations, psychiatric evaluations, counts of hospitalizations and clinic visits, and laboratory tests (immunosuppressant levels). We are presenting the descriptive analysis of this information. Results: We identified a total of 12 patients who received a KT for a primary diagnosis of lithium induced kidney disease at our center between 1/1/2004 and 12/31/2014. Eight (66%) were male and all were Caucasian. The most common co-occurring medical condition was hypertension 8 (66%) followed by hypothyroidism 4 (33.3%). Six (50%) had received hemodialysis before transplantation and 2 (16.5%) had received peritoneal dialysis, for an average dialysis duration of 2.35 years (±2.81). The post KT follow-up was 3.11 years (±2.26). Eleven (91.6%) had a diagnosis of Bipolar I disorder. The most commonly prescribed psychotropic medications were Lamotrigine (4 cases), followed by Quetiapine, Aripiprazole and Divalproex (3 cases each). One patient was continued on lithium through dialysis and after transplant. There were a total of 3 psychiatric hospitalizations corresponding to 0.08 hospitalizations per patient per year (PPY), 25 medical hospitalizations (average 2 per patient ±1.9) or 0.66PPY; infections 0.08 PPY, rejection 0.02PPY); instances of subtherapeutic medications level 0.21PPY. There was one death in the group. There were no instances of graft loss. Conclusion: Post-transplant exacerbations of psychiatric illness, psychiatric hospitalizations, graft loss, infections, and death were rare in patients receiving KT for lithium induced kidney disease at our center. Studying a higher number of patients with longer post-transplant follow-up, possible through multicenter registry, would provide more accurate information about the psychiatric and medical course of this group of KT recipients.