Purpose: Management of renal transplant recipients (RTRs) with bipolar disorder (BD) is complicated by risk factors for non-adherence, complex medication regimens and limited published guidance. We evaluated our single-center experience with RTRs with stable BD. Methods: We retrospective reviewed RTRs with a diagnosis of BD pre-transplant who received a RT at our center from March 2008 to Dec 2016. Results: Twenty-nine RTRs met inclusion criteria. Mean (SD) age of RTRs was 55±10 years, 69% were female and 82.6% were white. Indication for ESRD was lithium toxicity in 66% of RTRs. One patient had a prior RT, 83% received a deceased donor RT, 28% had cPRA > 20%, and 14% had DGF. For induction therapy, 26 RTRs (90%) received rabbit antithymocyte globulin (r-ATG), 2 received basiliximab, and 1 received r-ATG and basiliximab. Immunosuppression at discharge consisted of a calcineurin inhibitor (100%), mycophenolic acid (100%) and corticosteroids (90%). At 6 months, 97% of RTRs were still on steroids. Biopsy-proven rejection occurred in 1 RTR within the first month after RT; 2 additional RTRs received steroid pulses for presumed rejection within 6 months. No additional rejection episodes were noted at 1-year post RT. Patient and death-censored graft outcomes are shown in Table 1. SRTR data is included for comparison, which reports estimated probability of surviving with a functioning graft (unadjusted for patient/donor characteristics) at 1 year (for Jan 1, 2014-June 30, 2016) and 3 years (for July 1, 2011 to Dec 31, 2013). In our BD cohort, no deaths were due to psychiatric causes.

Conclusion: Short-term outcomes in RTRs with BD were similar to national data, and highly successful in this complex RTR group. The rejection rate was low, and RTRs with BD can be safely maintained on steroids to decrease rejection risk. Prospective studies are needed to determine best practices for long-term management of RTRs with BD.

CITATION INFORMATION: Hamel S., Sawinski D., Weinrieb R., Dave S., Trofe-Clark J. Outcomes in Renal Transplant Recipients with Bipolar Disorder: A Large Retrospective Cohort Am J Transplant. 2017;17 (suppl 3).

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