Patients with psychotic disorders in solid-organ transplant

Abstract

Background: Psychotic disorders are considered a relative or absolute contraindication to organ transplant, but information about their impact on transplant is limited.

Objective: To describe the clinical course of psychotic patients while they were on the waiting list and the outcomes of patients with psychotic disorders undergoing evaluation for organ transplant.

Methods: Thirty-eight transplant candidates with a diagnosis of psychotic disorder were analyzed in this descriptive study. The following variables were collected before transplant: demographics, type of transplant, cause of organ failure, medical comorbid conditions, and psychiatric variables (diagnosis, hospitalizations, treatment, substance abuse, family history, suicide attempts). For transplant recipients, the following posttransplant variables were recorded: rejection, toxic effects of medication, nonadherence, psychotic episodes (number, time interval after transplant), and number of hospitalizations.

Results: Of the 38 transplant candidates, 34 had a history of psychotic disorder before transplant. Nineteen (56%) of the 34 were listed for transplant, and 10 (29%) underwent transplant. Median follow-up time was 1.9 (IQR, 0.16-17.9) years. Among organ recipients with a history of psychotic disorders, psychiatric hospitalizations were 0.42 per patient per year (PPY), psychotic episodes 0.68 PPY, rejection 0.21 PPY, and toxic effects of immunosuppressants 0.05 PPY. None of the recipients lost their graft.

Conclusions: Patients with a history of psychotic disorder can do well after organ transplant. Further studies are needed with factor analyses including severity of psychosis, medication adherence, and associated comorbid conditions.