Pre-transplant depression as a predictor of adherence and morbidities after orthotopic heart transplantation

Abstract

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.

The impact of psychiatric disorders on outcomes following heart transplantation in children

“…This study highlights the importance of considering psychiatric co- 9,[11][12][13][14][15][16][20][21][22][23] Psychiatric disorders are associated with medication non-adherence, potentially contributing to the inferior patient outcomes observed. 4,11,[24][25][26] While the presence of psychiatric comorbidities was not independently associated with the overall freedom from rejection in our analysis, the incidence of rejection has decreased in the recent era, 27 potentially resulting in our analysis being underpowered. It is also conceivable that depression impacts a patients recognition of or willingness to report symptoms, potentially leading to further delays.…”

“…[4][5][6] Additionally, a number of adult studies have linked the presence of psychiatric diagnoses to adverse outcomes, including patients following solid organ transplantation. [7][8][9][10][11][12][13][14][15][16] It remains unclear if the presence of psychiatric disorders negatively influences patient outcomes following HTx in children. We aimed to assess the impact of disorders of depression, anxiety, and adjustment on outcomes in children undergoing HTx, including graft survival, freedom from readmission, and freedom from rejection.…”

Psychosocial factors and medication adherence among recipients of vascularized composite allografts

“…In SOT, social support, conscientiousness scores, and mental health factors were observed to be associated with post-transplant medication adherence. 5 – 7 These and other psychosocial factors may be of greater concern among VCA recipients, as many have faced psychological traumas or stigmatization prior to their transplant. 8 – 11 …”

Mental health and chemical dependency services at US transplant centers

“…Depression, PTSD, and personality disorders have been linked to decreased posttransplant medical compliance and higher resource utilization, and overall mental distress is associated with decreased health-related quality of life posttransplant. [7][8][9][10][11][12][13][14][15][16] Posttransplant depression is associated with graft rejection, malignancy, and mortality, 1,[17][18][19][20] as are smoking and substance use disorders. 21 A history of substance abuse or other risky health behaviors, low medication compliance, poor social support, psychosis, or cognitive dysfunction before transplant are strong indicators that these problems will return posttransplant and may affect medical compliance and outcomes.…”

“…Psychosocial problems in transplant candidates and recipients are associated with a number of poor outcomes. Depression, PTSD, and personality disorders have been linked to decreased posttransplant medical compliance and higher resource utilization, and overall mental distress is associated with decreased health‐related quality of life posttransplant . Posttransplant depression is associated with graft rejection, malignancy, and mortality, as are smoking and substance use disorders .…”