title: Managing psychosis in a renal transplant recipient with bipolar affective disorder and allograft rejection.
abstract: Management of mental health issues in the post-transplant setting can be difficult given the potential for medication related neurotoxicity. The lack of established guidelines in this area further compounds this difficulty. The current report details the course of patient with stable bipolar affective disorder prior to renal transplantation, who developed de novo psychosis post-transplantation as an adverse effect of her tacrolimus therapy. The patient was unable to take her usual oral immunosuppressants due to the severity of her psychosis and she eventually required alemtuzumab parenterally as rescue therapy from rejection. This case highlights the diagnostic and therapeutic challenges when dealing with transplant recipients with significant psychosis.
authors: Department of Nephrology, Monash Medical Centre, Melbourne, Victoria, Australia.
authors: Vatsa
authors: V
authors: Dave
authors: William
authors: W
authors: Mulley
authors: John
authors: J
authors: Kanellis
authors: Shaun
authors: S
authors: Summers
mesh_terms: D000284:Administration, Oral; D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004347:Drug Interactions; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D011605:Psychoses, Substance-Induced / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D012720:Severity of Illness Index; D020123:Sirolimus / Q000008:administration & dosage; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D014150:Antipsychotic Agents; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab; D020123:Sirolimus; D016559:Tacrolimus
keywords: alemtuzumab; psychosis; tacrolimus; transplantation