Depressive symptoms and mortality in lung transplant

Objective: To determine whether depressive symptoms predicted survival before and after lung transplantation. We hypothesized that depressive symptoms might predict survival of wait-listed patients, but would not predict survival post-transplant. Methods: This was a prospective, longitudinal study. Participants completed the Beck Depression Inventory pre-transplant. Pre-transplant survival analyses were conducted (n = 124) based on time from list date, to death, transplant, or censoring, if still alive. Post-transplant survival analyses were conducted (n = 76) based on time from transplant, to death or censoring. Cox proportional hazards regression analyses were utilized. Results: In the unadjusted model, depressive symptoms predicted mortality for candidates awaiting lung transplant (p = 0.02); however, once models were adjusted for demographics and pulmonary status, the relationship between depressive symptoms and mortality rates was attenuated (p > 0.05). Depressive symptoms did not predict survival after lung transplant (p > 0.05). Conclusions: Pre-transplant depressive symptoms were associated with mortality among lung transplant candidates in an unadjusted model and a model fit with demographics and forced expiratory volume in one second. Depressive symptoms do not exert an independent effect when forced expiratory vital capacity is added. Depressive symptoms do not predict mortality after transplant. Future studies need to determine whether pre-transplant psychosocial characteristics confer a greater risk for poorer transplant outcomes.