BackgroundPsychosocial factors are useful predictors of adverse outcomes after solid organ transplantation. Although depression is a known predictor of poor outcomes in patients who undergo orthotopic heart transplantation (OHT) and is actively screened for during pre-transplant evaluation, the effects of early identification of this entity on post-transplant outcomes are not clearly understood. The purpose of this study was to evaluate the impact of pre-transplant depression on outcomes after OHT.MethodIn this retrospective study, 51 patients that underwent psychosocial evaluation performed by a social worker prior to the transplant and followed up in our center post-transplant were enrolled. Patients were stratified by the presence/absence of depression during the initial encounter. Primary end-points were overall survival, 1st-year hospitalizations, overall hospitalizations, rejections, and compliance with medications and outpatient appointments.ResultsDepressed patients were 3.5 times more likely to be non-compliant with medications; RR = 3.5, 95% CI (1.2,10.2), p = 0.046 and had higher incidence of first year hospitalizations (4.7 ± 3.1 vs. 2.2 ± 1.9, p = 0.046), shorter time to first hospitalization 25 days (IQR 17–39) vs. 100 days (IQR 37–229), p = 0.001. Patients with depression also had higher overall hospitalizations (8.3 ± 4.4 vs. 4.6 ± 4.2, p = 0.025,) and higher number of admissions for infections (2.8 ± 1.3 vs. 1.5 ± 1.4, p = 0.018) compared to patients without depression. There were no statistically significant differences in total number of rejections or compliance with outpatient appointments. Kaplan-Meier survival analysis did not reveal differences between the two groups (mean 3705 vs. 3764 days, log-rank p = 0.52).ConclusionDepression was a strong predictor of poor medication compliance and higher rates of hospitalization in transplant recipients. No difference in survival between depressed and non-depressed patients after OHT was noted.

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Sensitization appears to have a negative effect on mortality. This mortality appears to be concentrated in patients with AMR, and we postulate that the development of AMR in a sensitized patient may be a predictor of mortality.

Aims Left ventricular assist devices (LVADs) are increasingly being used as life‐saving therapy for end‐stage advanced heart failure. Diabetes is prevalent in advanced heart failure patients. In this study, we sought to investigate the effects of mechanical circulatory support on diabetic parameters with LVAD implantation. Methods and results In this retrospective study, data on 244 LVAD recipients between 2006 and 2013 were reviewed. Patients without history of diabetes, death within the first 3 months after LVAD implantation, heart transplantation after LVAD, or LVAD explantation were excluded from the study. Baseline demographic, laboratory, and echocardiographic information prior to LVAD placement and 6‐month follow‐up were obtained. Laboratory values indicative of diabetic control were found to improve significantly at 6 months post‐LVAD implantation (glycated haemoglobin, 7.2 vs. 6.1%, P < 0.0001; serum fasting glucose, 141 vs. 122 mg/dL, P = 0.003; mean daily insulin dose, 30 vs. 24 IU/day, P = 0.02). Additionally, the use of oral hypoglycaemic medication was successfully discontinued in six patients at 6 months post‐LVAD implantation. Conclusions Long‐term LVAD therapy is associated with improvement in diabetic control which is probabvly due to improvements in cardiac output and normalization of biochemical derangements resulting from diabetes.