Pretransplant Depression, Antidepressant Use, and Outcomes of Orthotopic Liver Transplantation

Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Liver Transplantation (Impact Factor: 4.24). 03/2011; 17(3):251-60. DOI: 10.1002/lt.22231
Source: PubMed


Depression is a common problem among patients awaiting organ transplantation, but little is known about the impact of depression and its treatment on the outcomes of liver transplantation. In this retrospective cohort analysis, we studied all patients over 18 years of age who underwent liver transplantation during a 5-year period (2004-2008) at a single center. Among 179 recipients, 65 patients had depression, as defined by a health care provider assessment, before transplantation. Depression was defined as past or active depression or an adjustment disorder. The associations between pretransplant depression and various outcomes (time to death, graft failure, first acute cellular rejection episode, first infection, and first rehospitalization) were assessed. In the entire sample, more patients with depression required posttransplant psychiatric care (37% versus 18%); the adjusted hazard ratio was 2.28 (1.27-4.11). The rates of other outcomes, including hospital readmission, acute cellular rejection, graft failure, mortality, and infection, were similar for patients with depression and patients without depression. Among those with depression, patients on antidepressants at the time of transplantation had acute cellular rejection less frequently than those not taking antidepressants (13% versus 40%); the adjusted hazard ratio was 0.14 (0.03-0.62). The rates of other outcomes were similar between these 2 groups. These data indicate that depression affects posttransplant psychiatric morbidity but not other medical outcomes of liver transplantation. Pharmacological treatment of depression may significantly reduce the incidence of acute cellular rejection in patients undergoing liver transplantation. However, future prospective studies of mental health and liver transplantation are required to definitively assess the effects of antidepressant medications on medical outcomes.

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Available from: Owen Stanley Surman, Oct 06, 2015
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    • "The results indicate that the presence of clinical depressive symptomatology in liver transplant recipients is associated with poorer quality of life. This could be explained by the relationship of this emotional state with worse therapeutic compliance [6] and even with these patients continuing to hold on to their sick role [5]. Moreover, when liver transplant recipients exceed the clinical threshold for depressive symptomatology, the fact of having had acute cellular rejection affects role-physical and bodily pain at long-term, showing great impairment in both dimensions. "
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    ABSTRACT: The objective of this study was to analyze the influence of two variables (acute cellular rejection and depressive symptomatology) on liver transplant recipients' quality of life. Using a 2 × 2 factorial design, two groups were selected: 44 patients who had acute cellular rejection and 44 patients without this medical complication. After an average of 6 years since the transplant, patients were assessed with the Hospital Anxiety and Depression Scale and the SF-36 Health Survey. Analysis of variance, t test for unpaired samples, and Cohen's d effect size index were applied. The presence of clinical depressive symptomatology negatively affected all dimensions of quality of life (P < .001; large effect sizes); and interactive effects between factors acute cellular rejection and depressive symptomatology were found in the dimensions role-physical (P = .049) and bodily pain (P = .017). Transplant recipients with clinical depressive symptomatology scored lower on both dimensions (role-physical, P = .110, d = 0.52, medium effect size; bodily pain, P = .001, d = 1.25, large effect size) if they had an acute cellular rejection. In contrast, if they did not exceed the clinical threshold for depressive symptomatology, there were no differences in these dimensions (role-physical, P = .239, d = -0.33, small effect size; bodily pain, P = .555, d = 0.16, null effect size) between transplant recipients with and without acute cellular rejection. Clinical depressive symptomatology is associated with poorer quality of life in liver transplant recipients; and the long-term differences in the dimensions role-physical and bodily pain between liver transplant recipients with and without acute cellular rejection depend on patients' mental health. Copyright © 2015 Elsevier Inc. All rights reserved.
    Transplantation Proceedings 02/2015; 47(1):100–103. DOI:10.1016/j.transproceed.2014.11.010 · 0.98 Impact Factor
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    ABSTRACT: Liver transplantation (LT) programs encounter patients with fulminant hepatic failure resulting from suicide attempts involving acetaminophen or multidrug ingestion. Members of transplant teams often have different opinions about whether these patients should be offered transplantation. Disagreements can delay the transfer of these patients to a transplant facility and negatively affect their management. Currently, transplant programs have no guidelines to help them with their decisions about the appropriateness of LT for these patients. Here we present a clinical case encountered at our facility, and we discuss ethical principles that should help programs to make informed decisions about transplantation for these patients.
    Liver Transplantation 01/2011; 17(9):1111-6. DOI:10.1002/lt.22332 · 4.24 Impact Factor
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    ABSTRACT: Given that the prevalence of psychiatric disorders in transplant candidates and recipients is substantially higher than in the general population, and that linkages between psychiatric disorders and medical outcomes for nontransplant-related diseases have been established, it is important to determine whether psychiatric disorders predict posttransplant medical outcomes. Most research has focused on the association between depression (both pretransplant and posttransplant) and posttransplant mortality. Some research has examined transplant-related morbidity outcomes, such as graft rejection, posttransplant malignancies, and infection. However, methodological limitations make it difficult to compare existing studies in this literature directly. Overall, the studies presented in this review indicate that psychiatric distress occurring in the early transplant aftermath bears a stronger relationship to morbidity and mortality outcomes than psychiatric distress occurring before transplant. The literature on the impact of psychiatric conditions on the morbidity and mortality of solid organ transplant recipients remains inconclusive. More research is needed in order to investigate these associations among a broader range of psychiatric predictors, morbidity outcomes, and recipient populations. Until evidence suggests otherwise, we recommend frequent monitoring of psychiatric symptoms during the first year after transplantation to aid in early identification and treatment during this critical period of adjustment.
    Current opinion in organ transplantation 01/2012; 17(2):188-92. DOI:10.1097/MOT.0b013e3283510928 · 2.88 Impact Factor
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