title: Kidney transplantation complications related to psychiatric or neurological disorders.
abstract: Defining absolute psychiatric or neurological contraindications among kidney transplantation candidates is controversial, especially taking into account that graft outcomes are similar to other groups of patients. The social support network should be exhaustively evaluated to ensure adherence to immunosuppressive therapy and minimization of complications resulting from the neuropsychiatric disorder. We reviewed transplants (n = 668) in our center between January 2001 and August 2008 searching for patients with a diagnosis of neurological or psychiatric disease before renal transplantation. We also reviewed demographic data, social support networks, patient and graft survivals as well as transplant complications. Twelve patients were transplanted with neurological or psychiatric disorders: seven with cognitive impairment and five with psychiatric diseases. Nine patients had good social support networks. The mean follow-up time was 2.65 +/- 2.42 years. The graft loss rate was 34% (n = 4), including only one attributed to a mental disorder, namely, nonadherence to immunosuppressive therapy. Regarding complications, four were related to the neuropsychiatric disorder: hypoglycemia due to insulin overdose, aspiration pneumonia because of altered pharynx-larynx motility, hyponatremia related to diuretic abuse, and malnutrition plus dehydration. Patient survival in this period was 91.7%. The one patient died due to multiple organ failure secondary to respiratory sepsis with a functioning graft. In summary, neuropsychiatric disorders should not be considered to be contraindications for kidney transplantation although a social support network is essential and must be carefully evaluated.
authors.affiliation: Hospital Clínico San Carlos, Madrid, Spain. framos80@mail.com
authors.forename: F R
authors.initials: FR
authors.lastname: Carrasco
authors.forename: A
authors.initials: A
authors.lastname: Moreno
authors.forename: N
authors.initials: N
authors.lastname: Ridao
authors.forename: N
authors.initials: N
authors.lastname: Calvo
authors.forename: I
authors.initials: I
authors.lastname: Pérez-Flores
authors.forename: A
authors.initials: A
authors.lastname: Rodríguez
authors.forename: A
authors.initials: A
authors.lastname: Sánchez
authors.forename: M
authors.initials: M
authors.lastname: Marques
authors.lastname: Barrientos
mesh_terms: D000328:Adult; D000368:Aged; D003072:Cognition Disorders; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality / Q000523:psychology*; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology*; D010349:Patient Compliance; D011183:Postoperative Complications / Q000503:physiopathology* / Q000523:psychology*; D012189:Retrospective Studies; D012944:Social Support; D015996:Survival Rate; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome