Mental Health Disorders and Solid-Organ Transplant Recipients

Abstract

Depression affects up to 60% of solid-organ recipients and is independently associated with both mortality (hazard ratio for death of ~2) and de novo malignancy after transplantation, although the mechanism is not clear. Both pretransplantation psychosis and depression occurring more than 2 years after transplantation are associated with increased noncompliance and graft loss. It remains to be shown that effective treatment of depression is associated with improved outcomes and quality of life. Immunosuppressive drugs (especially corticosteroids and calcineurin inhibitors) and physiologic challenges can precipitate deterioration in mental health. All potential transplant candidates should be assessed for mental health problems and preexisting medical conditions that can mimic mental health problems, such as uremic, hepatic, or hypoxic encephalopathy, should be identified and treated appropriately. Expert mental health review of those with identified risk factors (such as previous suicide attempts, history of mental illness or noncompliance with medications) is advisable early in the transplant assessment process to mitigate risk and support the patient. Patients with mental health disorders, when adequately controlled and socially supported, have outcomes similar to the general transplant population. Therefore, exclusion from transplantation based on the diagnosis alone is neither ethically nor medically justified. However, it is ethically and clinically justifiable to deny access to transplantation to those who, despite full support, would have a quality of life that is unacceptable to the candidate or are likely to be noncompliant with treatment or follow-up, which would lead to graft loss.

Postoperative cognitive dysfunction after liver transplantation

“…Corticosteroids are associated with neuropsychiatric side effects in 3-4% of patients with a wide range of cognitive, affective, psychotic and behavioral symptoms. The majority of documented side effects results from "pulsed" large doses to treat graft rejection and occurs within days of LT [52]. Therefore, as both immunosuppressant and corticosteroids are possible etiological factors of POCD in the immediate posttransplant period, possibility that cognitive impairment reflects side effects of these two drug classes should be always ruled out.…”

Depression and Anxiety as Risk Factors for Morbidity and Mortality After Organ Transplantation

“…On the one hand, one might argue that any impact of depression or anxiety on outcomes would be attenuated in transplant populations, given routine use of psychiatric evaluation protocols designed to screen out or identify transplant candidates requiring mental health intervention before transplantation (2,4,6,19–21). On the other hand, despite such protocols, prevalence rates of clinically significant depression and anxiety in transplant recipients remain substantially elevated over rates in the general population, and they equal or exceed rates in other chronic disease cohorts.…”

“…Reviews summarizing these effects have been narrative rather than systematic reviews. With few exceptions(4), they focus on narrow portions of the literature—considering, for example, only certain types of transplantation, or only reports published during brief time periods such as the 12–18 months before the review(22,23,41–46). The reviews note that differences across studies are difficult to reconcile due to variations in study methodology, including the timing and nature of assessments of predictors and outcomes, and the duration of follow-up.…”

Organiczne zaburzenia urojeniowe u pacjentki po przeszczepie nerki – opis przypadku

“…zaburzenia depresyjne, lękowe, psychotyczne, zachowania samobójcze, zaburzenia snu oraz dysfunkcje seksualne [7,8]. W piśmiennictwie podkreśla się fakt, iż wystąpienie depresji u biorcy przeszczepu nerki jest niezależnym czynnikiem ryzyka zwiększonej chorobowości, gorszego funkcjonowania przeszczepu, jego odrzucenia i konieczności powrotu do dializ, a także śmierci [9,10,11,12]. Za przyczyny występowania zaburzeń depresyjnych w tej grupie pacjentów uznaje się współ-istnienie czynników patofizjologicznych (np.…”