Rational Guidelines for Transplantation in Patients with Psychotic Disorders

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This study investigated the outcomes of psychotic patients after transplantation to develop guidelines for rational decision-making with this group of transplant candidates. A survey was distributed to transplant programs in the United States, Canada, and Australia over a 2-year period, yielding 35 cases from 12 centers. Noncompliance resulted in rejection episodes in 14.7% of patients, with reduced function or graft loss in 11.8%. Noncompliance with immunosuppressant drugs was noted in 45.5% of those living alone versus 9.5% of patients living with someone. Suicide attempts were recorded in 35.7% of patients with psychotic symptoms in the year before transplantation, versus 5.9% for those without psychotic symptoms for 1 year before transplantation. Risk factors associated with problems after transplant included antisocial features, history of assault, borderline features, living alone, positive psychotic symptoms such as hallucinations and delusions, and a family history of schizophrenia.