Preventing cardiac allograft vasculopathy-long-term beneficial effects of MMF

Abstract

improve with time post-transplant (tx). However, this “average” pattern may conceal subgroups of patients with different patterns of adaptation--or failure to adapt--post-tx. Moreover, few reports consider distress beyond 1–2 years post-tx. We sought to identify unique patterns of change in psychiatric distress, and their predictors, over the first 4 years after heart tx. Procedures: All adults transplanted between 7/89–12/95 and surviving through 4 years post-tx received standardized interviews at 2, 7, 12, 36, and 42 mos. post-tx (N 156; refusal rate, 5.9%). Results: Cluster analysis identified 4 groups with either: low, clinically nonsignificant distress at all timepoints (45% of sample); high, clinically significant distress at all times (21%); distress during the first year with decline thereafter (18%); or a fluctuating pattern of distress over time (15%). Multivariate analysis identified key predictors of group membership. First, patients showing any distress (vs. none) were more likely to have a pre-tx history of psychiatric disorder, poor social supports and high physical functional impairment early post-tx, and continued physical impairment over time. Second, within the 3 groups of distressed patients, those with persistent (rather than improving) distress were most likely to be female, waited 6 months for tx, and had the most physical impairment early post-tx. While the persistent distress group had better social supports early post-tx, the supports markedly declined with time. Conclusions: Patients may show pronounced differences in whether and when their psychiatric distress levels abate after heart tx. Our results may inform the design of interventions to address each patient’s unique psychological needs post-tx.