The estimated nonadherence rates, overall and by transplant type, allow clinicians to gauge patient risk and target resources accordingly. Nonadherence rates in some areas--including immunosuppressant use--appear unacceptably high. Weak correlations of most patient psychosocial factors with nonadherence suggest that attention should focus on other classes of variables (e.g., provider-related and systems-level factors), which may be more influential.

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Lung recipients were neither uniformly better nor worse than heart recipients in adhering to their regimen. Lung recipients have particular difficulty with some home monitoring activities. Strategies to maximize adherence in both groups should build on caregiver support and on strengthening financial resources for patient healthcare requirements.

Objective Anxiety disorders are prominent in chronic lung disease; lung transplant recipients may therefore also be at high risk for these disorders. We sought to provide the first prospective data on rates and risk factors for anxiety disorders as well as depressive disorders during the first two years after transplantation. Method 178 lung recipients, and a comparison group (126 heart recipients), received psychosocial and Structured Clinical Interview for DSM-IV assessments at 2-, 7-, 12-, 18-, and 24-months posttransplant. Survival analysis determined onset rates and risk factors. Results The panic disorder rate was higher (p<.05) in lung than heart recipients (18% v. 8%). Lung and heart recipients did not differ on rates of transplant-related post-traumatic stress disorder (15% v. 14%), generalized anxiety disorder (4% v. 3%), or major depression (30% v. 26%). Risk factors for disorders included pretransplant psychiatric history, female gender, longer wait for transplant, and early posttransplant health problems and psychosocial characteristics (e.g., poorer caregiver support, use of avoidant coping). Conclusions Heightened vigilance for panic disorder in lung recipients and major depression in all cardiothoracic recipients is warranted. Strategies to prevent psychiatric disorder should target recipients based not only on pretransplant characteristics but early posttransplant characteristics as well.

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