ECT in A Renal Transplant Patient: Case Report

Out on PubMed, from clinicians in Roanoke, Virginia, is this case report:

ElectroconvulsiveTherapy in a Renal Transplantation Patient: A Rare Combination of Disease and Treatment.
Malaty G, Godbe K, Elmouchtari M, Malhi G, White J, Bankole A, Criss T.

Case Rep Psychiatry. 2020 Oct 30;2020:8889883. doi: 10.1155/2020/8889883. eCollection 2020.PMID: 33178474

The abstract is copied below:

The safety and efficacy of electroconvulsive therapy (ECT) for the treatment of psychiatric disorders have been demonstrated in a wide variety of patients, including postoperative patients and those who are pregnant. While several reports highlight the safety of this treatment in heart and liver transplantation patients, there is a relative lack of literature detailing the safety profile of ECT in an individual with recent kidney transplantation. Here, we explore the case of a patient with a recent renal transplant secondary to diabetes-related end-stage renal disease (ESRD) who underwent a successful course of ECT treatment. A 57-year-old Caucasian male with a past psychiatric history of schizoaffective disorder, bipolar type, and a past medical history of end-stage renal disease with recent right renal transplantation was admitted to the inpatient psychiatry unit. The admission was via a temporary detention order (TDO) for suicidality and auditory hallucinations promoting self-harm. The patient's depressive and delusional history was well-documented and had been refractory to several courses of psychotherapeutic and pharmacologic management. Electroconvulsive therapy was subsequently initiated and was well-tolerated. Treatments progressively alleviated his depressive and psychotic symptoms and did not adversely affect the function of his transplanted kidney, which was closely monitored throughout the treatment process. This case demonstrated the safety and efficacy of ECT treatment in an individual with recent renal transplant and may prompt further trials into establishing safety and efficacy in larger study populations.

The pdf is here.

While the title promises an interesting and instructive clinical case, and the authors are surely well-meaning, this report ultimately adds very little to the evidence base. The ECT was done 6 months after the renal transplant, so there is no reason to expect any related complications. The case starts with a strange description of ECT and a list of side effects, and the discussion fails to address several critical questions, including how soon after transplant surgery can ECT be performed safely. The case is poorly referenced and gives short shrift to the previous similar report from 2017.

One interesting management detail is the use of an intravenous calcium channel blocker (clevidipine, (Cleviprex)) for blood pressure control during the treatments.