Outcomes of Renal Transplantation in Patients With Bipolar Affective Disorder and Schizophrenia: A National Retrospective Cohort Study.

BACKGROUND: Patients with severe psychiatric disorders such as schizophrenia and bipolar affective disorder (BPAD) have in the past been excluded from organ transplantation programs based on their psychiatric illness. However, there is little data on the outcomes of renal transplantation in these patients and little evidence to support such exclusion. METHODS: We reviewed the database of the Irish National Renal Transplant Programme and identified all patients with a history of BPAD or schizophrenia who had received a transplant over a 28-year period. Data were collected for the following outcomes: patient survival, graft survival, graft function, length of hospitalization for transplantation, and frequency of acute rejection episodes. The control group was the general transplant group, that is, all patients without these psychiatric disorders and who had received a renal transplant during the relevant time period. RESULTS: Between January 1, 1986, and December 31, 2013, 3000 renal transplants were performed at our center. Of the transplant recipients, 0.5% (n = 15) had a diagnosis of BPAD and 0.2% (n = 6) had schizophrenia. No significant differences were found between the BPAD or schizophrenia group and the general renal transplant group in relation to patient survival, graft survival, and graft function. In addition, length of hospital admission for transplantation and frequency of acute rejection episodes were comparable among the 3 groups. CONCLUSIONS: Although consideration of psychiatric comorbidity is an important part of pretransplant assessment and selection, patients should not be discriminated against based on a diagnosis of BPAD or schizophrenia as there is no evidence that this negatively affects transplant outcomes.

Survival akin to injury, hospitalized patients with acute kidney injury based on the AKIN classification.

INTRODUCTION: Acute kidney injury (AKI) is often associated with severe consequences. The aim of the study was to determine whether the acute kidney injury network classification predicts hospital stay, renal recovery and mortality. METHODS: Hospitalized patients who were referred to the nephrology service over 6 months were studied retrospective with further 12 months prospective follow up. Statistical analysis was performed on their demography and outcome. RESULTS: Among the 238 patients who were referred, 166 had AKI, median age 74 years and 32% were diabetics. 10% (n = 17) required acute renal replacement therapy. The overall all-cause mortality of AKI group (n = 166) compared to non-AKI group (n = 72) at 1 year was 55% as opposed to 27.8% (p < 0.001). There was a significant statistical difference in the composite outcome and survival between the AKI stages in terms of renal recovery (p = 0.018). The AKI group had a median 8 day increase in length of stay compared to the non-AKI group (20 vs. 12 days; p = 0.0175). However, there was no significant statistical difference between pre and post admission AKI (p value = 0.191). CONCLUSION: The AKIN staging of AKI predicts both early and late mortality. AKI has a major impact on inpatient and 1-year-survival, renal recovery and length of stay. AKI and renal recovery following the insult were independent prognosticators. Early identification and management of AKI cases can help to prevent progression of the severity of AKI and therefore, mandates timely referral to nephrology team to prevent progression of AKIN class and its consequences.

Effect of perioperative blood transfusions on long term graft outcomes in renal transplant patients.

BACKGROUND: It is established that blood transfusions will promote sensitization to human leucocyte antigen (HLA) antigens, increase time spent waiting for transplantation and may lead to higher rates of rejection. Less is known about how perioperative blood transfusion influence patient and graft outcome. This study aims to establish if there is an association between perioperative blood transfusion and graft or patient survival. MATERIALS AND METHODS: This was a single center, national, retrospective cohort study. Data was collected on patients who received kidney transplants over a 14-year period (n = 2,013). The primary outcomes were graft survival and mortality in patients who received blood transfusions in the perioperative period compared to those who did not. RESULTS: Patients who received blood transfusions had lower hemoglobin levels, were more likely to be male, and had higher rates of delayed graft function compared to those who did not receive a transfusion. The one year graft survival of those transfused was 83% compared to 94% in those not transfused (p = < 0.0001). Adjustment for confounding showed that the receipt of a blood transfusion remained associated with increased graft loss. Hemoglobin levels prior to transfusion did not have an influence on graft outcome. CONCLUSION: Perioperative blood transfusion is associated with reduced long-term graft survival.