Neurobehavioral Functioning and Survival Following Lung Transplantation

Smith, Patrick J.; Blumenthal, James A.; Carney, Robert M.; Freedland, Kenneth E.; O’Hayer, C. Virginia F.; Trulock, Elbert P.; Martinu, T.; Schwartz, Todd A.; Hoffman, Benson M.; Koch, Gary G.; Davis, Robert D.; Palmer, Scott M.

doi:10.1378/chest.12-2127

Cited by 64 publications

(60 citation statements)

References 29 publications

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“…Thus, we cannot know in how many patients depression and social isolation remained stable until time of transplant. It is conceivable that depression and social isolation are particularly detrimental when present until time of transplant, as has been shown for depressive symptoms in lung transplantation 41. However, because depression tends to increase during the waiting period42 and has been shown to remain stable when present after HTx,43 the associations observed in the present study may actually be underestimated.…”

Section: Discussionmentioning

confidence: 59%

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

Spaderna

Zittermann

Reichenspurner

et al. 2017

JAHA

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BackgroundWe evaluated depression and social isolation assessed at time of waitlisting as predictors of survival in heart transplant (HTx) recipients.Methods and ResultsBetween 2005 and 2006, 318 adult HTx candidates were enrolled in the Waiting for a New Heart Study, and 164 received transplantation. Patients were followed until February 2013. Psychosocial characteristics were assessed by questionnaires. Eurotransplant provided medical data at waitlisting, transplantation dates, and donor characteristics; hospitals reported medical data at HTx and date of death after HTx. During a median follow‐up of 70 months (<1–93 months post‐HTx), 56 (38%) of 148 transplanted patients with complete data died. Depression scores were unrelated to social isolation, and neither correlated with disease severity. Higher depression scores increased the risk of dying (hazard ratio=1.07, 95% confidence interval, 1.01, 1.15, P=0.032), which was moderated by social isolation scores (significant interaction term; hazard ratio = 0.985, 95% confidence interval, 0.973, 0.998; P=0.022). These findings were maintained in multivariate models controlling for covariates (P values 0.020–0.039). Actuarial 1‐year/5‐year survival was best for patients with low depression who were not socially isolated at waitlisting (86% after 1 year, 79% after 5 years). Survival of those who were either depressed, or socially isolated or both, was lower, especially 5 years posttransplant (56%, 60%, and 62%, respectively).ConclusionsLow depression in conjunction with social integration at time of waitlisting is related to enhanced chances for survival after HTx. Both factors should be considered for inclusion in standardized assessments and interventions for HTx candidates.

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Section: Discussionmentioning

confidence: 59%

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

Spaderna

Zittermann

Reichenspurner

et al. 2017

JAHA

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“…Our finding that executive functioning, as measured by Trail Making Test part B, worsened after transplant may have important implications for patient management because executive functioning is predictive of self-management and objectively measured adherence among older adults (34). Indeed, previous studies among primary care patients have demonstrated that better executive function is associated with more than a 3-fold greater likelihood of medication adherence after adjustment for background ORIGINAL RESEARCH characteristics (35), and we have previously shown that poorer executive functioning before lung transplantation is associated with greater mortality after transplant (21).…”

Section: Discussionmentioning

confidence: 85%

“…The presence of neurocognitive deficits before transplantation has been shown to be associated with poorer clinical outcomes, including mortality (21). Neurocognitive deficits after transplantation are important because intact neurocognitive functioning is critical for decision-making capacity and for the ability to manage a complex medical regimen, both of which are essential elements of post-transplant care (28).…”

Section: Discussionmentioning

confidence: 99%

“…The composite score was created by calculating individual z-scores for each test and then summing the scores, an approach we have used previously (21,22) and that is recommended over modeling each predictor individually because it increases statistical power and reduces type-I error (23,24). Because age was confounded with native disease (patients with cystic fibrosis [CF] are younger than patients without CF), we did not control for age in our primary analyses of neurocognitive function.…”

Section: Methodsmentioning

confidence: 99%

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Neurocognitive Changes after Lung Transplantation

Smith¹,

Rivelli²,

Waters³

et al. 2014

Annals ATS

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“…Two different instruments were used to investigate generic (36-item Short Form Health Survey, SF-36) and disease-specific (Saint George's Respiratory Questionnaire, SGRQ) HRQoL [1,14,15]. Items not answered were treated as for questionnaire scoring instructions.…”

Section: Health-related Quality Of Life Instrumentsmentioning

confidence: 99%

Changes in quality of life and functional capacity after lung transplantation: A single-center experience

Ricotti

Martinelli

Caspani

et al. 2017

Monaldi Arch Chest Dis

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Lung transplantation (LT) increases the life expectancy of patients affected by end stage pulmonary disease; specifically, its ultimate aims are to improve survival and health related quality of life (HRQoL). The aim of the present longitudinal study was to determine the HRQoL trajectory and changes in functional capacity from time of entry in the waiting list for LT to 2 year after LT. The study included sixty-nine outpatients enrolled in a single medical center when they entered the waiting list for LT and who subsequently received it. They were then followed up over 2 years after LT. HRQoL was assessed by the physical and mental component summary (PCS and MCS) scores of the 36-item Short Form Health Survey (SF-36) and Saint George's Respiratory Questionnaire (SGRQ). Psychological distress was evaluated with the General Health Questionnaire (GHQ), and functional capacity was investigated using the six-minute walk test (6MWT) and forced expiratory volume (FEV1). Patients showed low SF-36 PCS (30.5±7.8) and SGRQ total (61.8±17.5) scores at entry in the waiting list, but exhibited significant changes over time after LT (p<0.001). Furthermore, patients who showed an increase of at least 50% in SF36 PCS and SGRQ scores at 6 months survived longer. Both FEV1 and 6MWT distance as well as GHQ scores significantly changed over time, with improvements occurring in the first 6 months after LT but no major changes thereafter. Out of the 69 patients enrolled, 32 died over a median follow-up of 51 months. Although mortality tended to be slightly higher for patients with lower HRQoL at the baseline assessment, this difference was not statistically significant. HRQoL evaluations appear critical in the follow-up of LT candidates, in particularly SGRQ, because of its specificity in targeting respiratory symptoms and functional wellbeing.

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Neurobehavioral Functioning and Survival Following Lung Transplantation

Cited by 64 publications

References 29 publications

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

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

Neurocognitive Changes after Lung Transplantation

Changes in quality of life and functional capacity after lung transplantation: A single-center experience

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