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.
Highlights
Psychosocial factors are useful predictors of adverse outcomes after solid organ transplantation
Depressed 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
Depression was a strong predictor of poor medication compliance and higher rates of hospitalization in transplant recipients
Summary
Psychosocial factors are useful predictors of adverse outcomes after solid organ transplantation. The purpose of this study was to evaluate the impact of pre-transplant depression on outcomes after OHT. Depression continues to remain a strong predictor of morbidity and mortality in patients with chronic medical conditions [1, 2]. Many risk factors for post-cardiac transplant morbidity and mortality are well –defined and include: heart failure etiology, recipient age, donor age, body mass index, history of previous transplantation, impaired renal function, number of rejection episodes, and cardiac allograft vasculopathy [8]. Psychosocial risk factors are used to determine eligibility for placement on a heart transplant waiting list, few studies have examined the validity of such factors in predicting post-transplant outcomes. Several studies reported no association between psychosocial factors and mortality [9,10,11,12], while others have found that several psychiatric risk factors and social/demographic
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