*Purpose: Management of kidney transplant recipients (KTRs) with bipolar disorder (BD) is complicated by risk factors for non-adherence, complex medication regimens and limited published guidance. We sought to evaluate our single-center experience with BD KTRs compared to matched controls.

*Methods: We retrospectively reviewed KTRs age 18 ≥ yrs with a BD history who were transplanted at our center from March 1, 2008-Dec 31 2016. Control KTRs were randomly selected from our center and matched 1:1 to BD KTRs based on age (±5 yrs), reported gender and ethnicity, and KTR date within 6 mos of BD KTR. Multi-organ and HIV+ KTRs were excluded. We also compared results to 2017 SRTR data which reports estimated probability of surviving with a functioning graft (unadjusted for patient/donor characteristics) at 1 yr (for July 1, 2014-Dec 31, 2016) and 3 yrs (for Jan 1, 2012-June 30, 2014).

*Results: Sixty-four KTRs met inclusion criteria (32 BD and 32 matched controls). Overall, mean age was 54 yrs, 63% were female and 88% were white. Renal failure cause was lithium toxicity in 63% BD KTRs vs 0% controls (p< 0.01). Three percent of BD KTRs vs 22% controls had a history of prior transplant (p=0.05), 78% of BD KTRS vs 66% controls were deceased donor KTRs (p=0.40), and 16% of BD KTRs vs 19% controls had delayed graft function (p=1.00). Discharge immunosuppression included a calcineurin inhibitor and mycophenolic acid in 100% of KTRs in both groups and steroids in 91% of BD KTRs vs 94% controls. At 1 yr, 97% of KTRs in both groups were on steroids. Psychiatric comorbidities were similar (16% in each group). Patient and graft outcomes in BD KTRs vs controls were similar and comparable to national outcomes (Table 1). Rejection occurred in 3% of KTRs in both groups by 1 yr. Mean (SD) follow-up for BD KTRs was 4.3 ± 2.7 yrs vs 4.4 ± 2.7 yrs for controls (p=0.82). No deaths were due to psychiatric complications in BD KTRS.

*Conclusions: Short-term outcomes in BD KTRs were similar to matched controls and national data, and highly successful in this complex KTR group. BD KTRs can be safely maintained on steroids to decrease rejection risk. Psychiatric comorbidities rates in BD KTRs were comparable to matched controls. Future research will evaluate medication non-adherence rates between groups. Prospective studies are needed to determine best practices for long-term management of BD KTRs.

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