The use of cyclosporine and tacrolimus therapy in nonrenal (heart, heart/lung, lung, and liver) transplantation has resulted in improved patient and graft survival. Nephrotoxicity is one of the major side effects of tacrolimus and cyclosporine therapy and may lead to ESRD. The trend of referral of nonrenal solid-organ transplant recipients for kidney transplant evaluation at a large multiorgan transplant center was examined. Records of all patients who were referred for renal transplantation at the University of Alabama between January 1, 1993, and June 30, 2004, were reviewed. Eighty (0.96%) of 8318 individuals had previously undergone a nonrenal solid-organ transplant and were included in the study. The majority (72%) of patients had their nonrenal transplants performed at the University of Alabama. Twenty-two patients had their nonrenal transplant performed elsewhere and had fewer data available for analysis. From the period 1993-1996 to 2001-2004, an 11-fold increase in the absolute number of referrals of patients with nonrenal transplants was noted. Of patients who were referred for transplant evaluation, 25 became recipients of kidney transplants with a predominance of living-donor transplants. Referral for kidney transplant evaluation among nonrenal solid-organ transplant recipients is increasing and will exacerbate the existing shortage of deceased-donor kidneys that are available for transplantation. There was a trend for liver transplant recipients compared with other solid-organ recipients to develop ESRD at a greater rate.
collected from the medical record and self-administered questionnaires. Depressive symptoms were assessed by the Patient Health Questionnaire-9 (PHQ) (range, 0-27). SOC was assessed by the 13-item SOC scale by Antonovsky et al (range, 13-91). To assess an association of depression with SOC after adjustment for age, logistic regression analysis was performed with the presence of mild or more severe depression (defined as the PHQ score of more than 5) as dependent variable. Results: At 3 months after LVAD implantation, depressive symptoms were significantly improved (PHQ score, 6.7±5.6 to 4.9±4.8, p= 0.02), but still 27% (n= 9) had mild (10 > PHQ score ≥ 5) and 18% (n= 6) had moderate or severe depression (PHQ score ≥ 10). Preoperative SOC (54.8±7.7) did not influence on postoperative depressive symptoms (n= 24, r=-0.06, p= 0.77), whereas postoperative higher SOC (53.8±7.3) was significantly related to less depressive symptoms (n= 33, ρ =-0.53, p< 0.01). Logistic regression analysis showed that postoperative higher SOC was associated with a decrease risk of depression independent of age (odds ratio= 0.87, 95% confidence inter-val= 0.77-0.98, p= 0.02). Conclusion: Although depressive symptoms are lower at 3 months after LVAD implantation, depression is still a common mental problem reported by 45% of the patients. Postoperative lower SOC is an important factors to identify patients at high risk for depression.
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