Psychiatric Predictors of Long-term Transplant-Related Outcomes in Lung Transplant Recipients

Background Long-term survival after lung transplantation remains poor, yet modifiable risk factors for late-term morbidity and mortality have yet to be identified. Because psychiatric disorders increase risk for poor health outcomes in many nontransplant chronic disease populations, lung recipients with depression or anxiety before or early after transplantation may be at heightened risk for late-term transplant-related morbidity and mortality. Methods Among 178 patients from a prospective study of mental health after lung transplantation, we identified 1-year survivors and examined whether they experienced major depression or anxiety disorders during that year as well as before transplantation. We used multivariable Cox regression to examine the relationship between these disorders and risk for subsequent bronchiolitis obliterans syndrome (BOS), mortality and graft loss for up to 15 years posttransplant, controlling for other known risk factors for the outcomes. Results One hundred fifty-five recipients were studied. Recipients with posttransplant depression had an elevated risk of BOS (hazard ratio [HR], 1.91; 95% confidence interval [95% CI], 1.10-3.31), patient death (HR, 1.65; 95% CI, 1.01-2.71) and graft loss (HR, 1.75; 95% CI, 1.06-2.88). A trend toward reduced risk of BOS was observed in recipients with posttransplant anxiety (HR, 0.61; 95%CI, 0.37-1.00). Neither pretransplant disorder was related to risk for any outcome. Conclusions Early posttransplant depression increases risk for long-term transplant-related morbidity and mortality. Screening to identify depression should therefore be routine in posttransplant care. Although anxiety was not significantly associated with poor outcomes, screening for posttransplant anxiety should also be routine, to reduce patient distress. Research is needed to better understand mechanisms underlying depression-outcome associations.