Early Treatment of Depressive Symptoms and Long-Term Survival After Liver Transplantation

Abstract

While depression after liver transplantation (LTX) is associated with decreased survival, the effects of treating depression remain unknown. We assessed a previously-described, prospective cohort of 167 patients transplanted for alcohol-related liver disease from 1998–2003. Depressive symptoms were measured with the Beck Depression Inventory serially throughout the first post-transplant year. Adequacy of antidepressant treatment was measured with the Antidepressant Treatment History Form. Using Cox-proportional Hazards modeling, survival times were assessed for recipients with no depression vs. depression with adequate medications vs. depression with inadequate medications. Seventy-two recipients had depressive symptoms in the first post-transplant year. Of these, 43% (n=31) received adequate pharmacotherapy and 57% (n=41) received inadequate (n=7) or no pharmacotherapy (n=34). After a median follow-up time of 9.5 years, 32% of the inadequately treated depressed group survived vs. 52% of the adequately treated group and 56% of the non-depressed group (p=0.006). Compared to the non-depressed group, those with adequately treated depression had no significant difference in survival. However, recipients with depression and inadequate pharmacotherapy had decreased survival times compared to non-depressed recipients (HR for death=2.44, 95% CI=1.45, 4.11), controlling for other known confounders. The factor most strongly linked to long-term mortality after liver transplantation in this cohort was untreated depression.

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

“…We need not await an understanding of mechanisms by which depression increases mortality risk before proceeding with risk-reduction activities. An observational study hints at the potential impact of such work within transplantation: Rogal et al(72), in additional analyses of the DiMartini et al cohort(31) included in the present meta-analysis, found that liver recipients who received adequate, evidence-based pharmacotherapy for early post-transplant depression had long-term survival equivalent to that of nondepressed recipients, while depressed recipients receiving inadequate or no treatment had poorer survival. Important next steps include randomized trials to determine if such effects are causal and robust.…”

Psychosocial Predictors of Mortality Following Lung Transplantation

“…The present study extends these data by demonstrating that negative affect following transplantation, which had not previously been examined, was associated with increased mortality. Although few studies have examined depressive symptoms or distress as a predictor of survival following cardiothoracic transplant, at least one previous study has shown that inadequately treated depressive symptoms are associated with greater mortality among liver transplant recipients (28). In addition, persistently elevated depressive symptoms and higher levels of anger–hostility have been shown to predict chronic graft rejection during the first three years following heart transplantation (29).…”

Complications and Their Resolution in Recipients of Deceased and Living Donor Liver Transplants: Findings From the A2ALL Cohort Study

“…Some complications, such as hernia, psychological decompensation, and ascites, did not achieve resolution. Although patients with treated depression have been shown to have equivalent medical outcomes to non-depressed patients, there may be an impact on long-term post-transplant quality of life (15). …”