Cardiac Transplantation: Clinical Correlates of Psychiatric Outcome

Abstract

Seventy cardiac transplantation cases were studied to determine the association between psychiatric disturbances, psychosocial adjustment, and postoperative course. Fourteen of 19 patients for which reservations were expressed about suitability for transplantation developed postoperative surgical or psychiatric complications. Psychiatric complications, mostly organic mental disorders, occurred in 24 of 70 patients postoperatively; 10 patients manifested a steroid-induced psychosis, and seven manifested psychosis induced by renal, hepatic, or other end-stage organ disease. Affective disturbances also were prominent, usually occurring later in the postoperative course; 11 affectively ill patients required psychiatric intervention and follow-up. The study demonstrated a significant association between assignment of a preoperative DSM-IJI Axis I diagnosis and dissatisfaction with surgical outcome (12% of sample, p < .05) and/or history of sudden onset of cardiac failure (22% of sample, p < .05). Despite reservations about suitability for transplantation and postoperative complications, transplantation survivors demonstrated improvements on the SSAI, the Zung SDS, and the Psychosocial Adjustment to Illness Scale six to 12 months following surgery (p < .03).