Depression and Anxiety as Risk Factors for Morbidity and Mortality After Organ Transplantation

Abstract

Background Depression and anxiety are common mental health problems in transplant populations. There is mixed evidence concerning whether they increase morbidity and mortality risks post-transplant. If such associations exist, additional risk reduction strategies may be needed. Methods Four bibliographic databases were searched from 1981 through September, 2014 for studies prospectively examining whether depression or anxiety (determined with diagnostic evaluations or standardized symptom scales) affected risk for post-transplant mortality, graft loss, acute graft rejection, chronic rejection, cancer, infection, and rehospitalization. Results Twenty-seven studies (10 heart, total n=1,738; 6 liver, n=1,063; 5 kidney, n=49,515; 4 lung, n=584; 1 pancreas, n=80; 1 mixed recipient sample, n=205) were identified. In each, depression and/or anxiety were typically measured pre- or early post-transplant. Follow-up for outcomes was a median of 5.8 years (range:0.50–18.0). Depression increased the relative risk (RR) of mortality by 65% (RR=1.65, 95% CI:1.34,2.05; 20 studies). Meta-regression indicated that risk was stronger in studies that did (v. did not) control for potential confounders(p=.032). Risk was unaffected by type of transplant or other study characteristics. Depression increased death-censored graft loss risk (RR=1.65, CI:1.21,2.26, 3 studies). Depression was not associated with other morbidities (each morbidity assessed in 1–4 studies). Anxiety did not significantly increase mortality risk (RR=1.39, CI:0.85,2.27, 6 studies) or morbidity risks (assessed in single studies). Conclusions Depression increases risk for post-transplant mortality. Few studies considered morbidities; the depression-graft loss association suggests that linkages with morbidities deserve greater attention. Depression screening and treatment may be warranted, although whether these activities would reduce post-transplant mortality requires study.

Peak oxygen uptake and self‐reported physical health are strong predictors of long‐term survival after heart transplantation

“…As it is found that depressed HTx recipients have a higher risk of mortality, screening for depressive symptoms during follow-up is recommended (69)(70)(71). As an approach to increase mental health, the effect of exercise and HIT has been studied.…”

Role of Depression and Social Isolation at Time of Waitlisting for Survival 8 Years After Heart Transplantation

“…Therefore, these studies cannot provide any evidence whether depression and social factors present at time of waitlisting impact transplant outcomes and whether systematic assessment of these patient characteristics should already be part of the pretransplant evaluation. A recent meta‐analysis of heart, liver, kidney, lung, and other solid organ transplant patients found depression in general to be related to adverse posttransplant outcomes 18. However, this meta‐analysis included only 4 (smaller single‐center) studies of HTx patients with a pretransplant assessment of depression, which have reported conflicting findings 19, 20, 21, 22.…”

Association of depression and anxiety before heart transplant with mortality after transplant: a single-center experience

“…The depression with anxiety group's means for the BDI-II and STAI instruments were higher than those reported by the Florida Cardiac Cohort Normative Descriptive Measures (14): BDI-II =13.9 (versus 10.58), State Anxiety =40.2 (versus 37.26), and Trait Anxiety =40.6 (versus 34.57), suggesting worse depression and anxiety severity in our patients with both depression and anxiety compared to a broad heart failure group.…”

“…The median duration of follow-up of all the papers cited in the meta-analysis was 5.8 years. 14 We did not see a relationship at 5 years. The risk may be much higher during a shorter term, as our study found that at 2-3 years, it diminishes with time.…”