Bipolar disorder (BD) is common, affecting ∼1% of the population. Lithium (LI) is effective therapy for BD but increases the risk of end-stage renal disease (ESRD). Newer treatments for BD are now available that enable patients to have BD well controlled on non-nephrotoxic regimens. Uncontrolled BD is a contraindication to renal transplant. However, patients with well controlled BD who progress to ESRD may be candidates for renal transplant (RT). There are few data on outcomes in patients with BD following RT.

METHODS: Single-center retrospective study of all adults with BD who received a RT from 7/1/02-12/31/11. All patients with BD underwent a thorough psychiatric and social evaluation prior to listing. In all patients, BD was well-controlled on a stable medical regimen, with no symptoms at the time of initial evaluation or transplant.

RESULTS: 15 patients with BD received a RT during this time. 14 patients had ESRD from LI and1 patient from hypertension. All patients received induction with thymoglobulin and were maintained on tacrolimus and mycophenolate; 86.7% underwent steroid withdrawal in the first week. Recipient characteristics are show in table 1.

Patient survival was 80%: 1 patient died of cardiac arrest 4 days after transplant, 1 patient died of lymphoma at 5 months, and 1 patient died of unknown causes at 4 years. Death-censored graft survival was 92.3%; 1 graft was lost to primary nonfunction. 2 patients had post-RT psychiatric hospitalizations, with 1 requiring a return to LI to control BD symptoms.

CONCLUSIONS: RT can be performed safely in stable patients with well controlled BD. There is a low risk of acute rejection and excellent intermediate-term graft survival. There is a small risk of decompensation of BD after RT requiring hospitalization, though it is unclear whether this is related to transplant-specific factors or the natural history of the disease. Well-controlled BD should not be considered a contraindication to renal transplant.

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