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

Abstract

Psychiatric disorders are common in pediatric HTx recipients. However, the impact of psychiatric comorbidities on patient outcomes is unknown. We aimed to assess the impact of disorders of adjustment, depression, and anxiety on HTx outcomes in children; hypothesizing that the presence of psychiatric disorders during or preceding HTx would negatively impact outcomes. All pediatric HTx recipients ≥8 years of age who survived to hospital discharge were identified from a novel linkage between the PHIS and SRTR databases (2002-2016). Psychiatric disorders were identified using ICD codes during or preceding the HTx admission. Post-transplant graft survival, freedom from readmission, and freedom from rejection were analyzed using the Kaplan-Meier method. Multivariable Cox proportional hazard models were used to adjust for covariates. A total of 1192 patients were included, of which 133 (11.2%) had depression, 197 (16.5%) had anxiety, and 218 (18.3%) had adjustment disorders. The presence of depression was independently associated with higher rates of readmission (60.9% vs 54.1% at 6 months) (AHR 1.63, 95% CI 1.22-2.18, P = .001) and inferior graft survival (70.2% vs 83.4% at 5 years) (AHR 1.62, 95% CI 1.14-2.3, P = .007). Anxiety was independently associated with higher rates of readmission (60.4% vs 53.9% at 6 months) (AHR 1.46, 95% CI 1.09-1.94, P = .01). Anxiety and depression in the pretransplant period are independently associated with outcomes following HTx in children. Evaluation and management of psychiatric comorbidities represents an important component of care in this vulnerable population.

Specific patterns of executive functioning weaknesses among children after heart transplant

“…Upon completion of this screener, the providers could refer the patient for a more comprehensive evaluation if warranted. In addition, it is also important to recall that youth with HT are at a higher risk of depression and anxiety than healthy controls 25–27 . The presence of such internalizing disorders may contribute to or exacerbate EF difficulties (e.g., trouble focusing in class due to intense worrying, increased inflexibility).…”

“…These risks are further compounded by findings that children with histories of HT are more at risk of depression and anxiety than healthy controls 25–28 . More specifically, recent research revealed that 27.7% of children with histories of HT met criteria for depression or anxiety, which is in contrast to the prevalence among the general youth population (approximately 7%) 25 . Additionally, patients with chronic illness may experience social difficulties due to feeling different from peers, which may further to mental health concerns such as anxiety and depression.…”

“…Such weaknesses are associated with poor adherence to medical regimens, which is of utmost importance to ensure long‐term survival and graft success 22–24 . These risks are further compounded by findings that children with histories of HT are more at risk of depression and anxiety than healthy controls 25–28 . More specifically, recent research revealed that 27.7% of children with histories of HT met criteria for depression or anxiety, which is in contrast to the prevalence among the general youth population (approximately 7%) 25 .…”

Long‐term outcomes for pediatric heart transplant recipients transitioning to adult care teams

“…Quinlan et al. retrospectively reviewed 1192 pediatric HT recipients at least 8 years or older, and similarly concluded that the presence of anxiety or depression was independently associated with higher rates of hospital readmission within 6 months of HT, and depression was also independently associated with inferior graft survival at 5 years 39 . While overall patient survival was excellent in our population, young adults with psychiatric illness are more likely to suffer from comorbidities related to their transplant soon after transition compared to those without a psychiatric diagnosis.…”

Depression in transplantation

“…Psychiatric disorders were identified using ICD codes during or preceding the admission for transplantation. One hundred and thirty-three or 11.2% of them had depression, and the presence of depression was independently associated with higher rates of readmission (60.9 vs. 54.1% at 6 months) [adjusted hazards ratio (aHR) 1.63, 95% CI 1.22-2.18, P ¼ 0.001] and inferior graft survival (70.2 vs. 83.4% at 5 years) (aHR 1.62, 95% CI 1.14-2.3, P ¼ 0.007) [58].…”