Background
Depression is prevalent in patients with heart failure and after heart transplant. We identified the prevalence of pre‐ and post‐transplant depression and its association with clinical characteristics and post‐transplant outcomes.
Methods
We reviewed 114 adults transplanted 1/1/2015 to 12/31/2015 and identified patients with pre‐ and post‐transplant depression. Clinical characteristics and outcomes were compared.
Results
Of 114 patients, 35.1% had pre‐transplant depression and 26.3% had post‐transplant depression. Patients with post‐transplant depression within the first year were significantly more likely to have acute rejection (10% vs 0%), longer intensive care unit (11.7 days vs 7.8 days) and hospital stay (31.7 days vs 16.3 days), and discharge to inpatient rehabilitation (26.7% vs 8.3%). Patients with post‐transplant depression within the first year had significantly higher 5‐year mortality (30% vs 9.5%, p = .009). However, after adjustment for total artificial heart/biventricular assist device, acute rejection, intensive care unit, and hospital length of stay, this relationship was no longer significant (HR 2.11; 95% CI 0.18‐25.27; p = .556).
Conclusions
Depression is common among heart transplant candidates and recipients. While pre‐transplant depression did not impact outcomes, patients with post‐transplant depression were more likely to have had a complicated course, suggesting the need for increased vigilance regarding depression in such patients.
Background: The incidence of recurrent laryngeal nerve injury (RLNI) after heart transplantation has not been well studied. This can manifest as vocal cord dysfunction causing dysphonia. Previous research is limited to aortic, coronary bypass, and valvular surgery. Identifying RLNI after heart transplantation is important in order to more accurately detail complications associated with this major surgery. Methods: This is a retrospective study assessing 972 adult patients who underwent orthotopic heart transplantation between 2010-2019. Primary outcome was incidence of RLNI. Secondary outcomes were 1-year mortality and length of stay. Cardiology and otolaryngology notes were examined. Key word searches were used to identify possible RLNI in patients' health care record. Results: 2.9% (29/972) of patients developed new RLNI confirmed by laryngoscopy during hospitalization. Patients with RLNI had a significantly increased risk of 1-year mortality (P = .015) and length of stay (P = .006) compared to those without RLNI. 68.9% (20/29) of RLNI was left-sided (68.9%). Conclusions: Recurrent laryngeal nerve injury is a recognizable adverse outcome following heart transplantation. This study supports that RLNI is associated with increased 1-year mortality and length of stay. Early otolaryngology evaluation may be warranted to evaluate vocal cord mobility and address potential management.
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