Pretransplant depression, antidepressant use, and outcomes of orthotopic liver transplantation

Abstract

Depression is a common problem among patients awaiting organ transplantation, but little is known about the impact of depression and its treatment on the outcomes of liver transplantation. In this retrospective cohort analysis, we studied all patients over 18 years of age who underwent liver transplantation during a 5-year period (2004)(2005)(2006)(2007)(2008) at a single center. Among 179 recipients, 65 patients had depression, as defined by a health care provider assessment, before transplantation. Depression was defined as past or active depression or an adjustment disorder. The associations between pretransplant depression and various outcomes (time to death, graft failure, first acute cellular rejection episode, first infection, and first rehospitalization) were assessed. In the entire sample, more patients with depression required posttransplant psychiatric care (37% versus 18%); the adjusted hazard ratio was 2.28 (1.27-4.11). The rates of other outcomes, including hospital readmission, acute cellular rejection, graft failure, mortality, and infection, were similar for patients with depression and patients without depression. Among those with depression, patients on antidepressants at the time of transplantation had acute cellular rejection less frequently than those not taking antidepressants (13% versus 40%); the adjusted hazard ratio was 0.14 (0.03-0.62). The rates of other outcomes were similar between these 2 groups. These data indicate that depression affects posttransplant psychiatric morbidity but not other medical outcomes of liver transplantation. Pharmacological treatment of depression may significantly reduce the incidence of acute cellular rejection in patients undergoing liver transplantation. However, future prospective studies of mental health and liver transplantation are required to definitively assess the effects of antidepressant medications on medical outcomes.

Association between depression and hospital outcomes among older men

“…ticipate in a follow-up study between Oct. 1,2001, and Aug. 31, 2004. The 4263 men who attended a face-to-face follow-up survey and the 1322 who completed a follow-up questionnaire constitute the Health in Men Study cohort (n = 5585).…”

Review article: depression and the use of antidepressants in patients with chronic liver disease or liver transplantation

“…A retrospective analysis of patients with end-stage liver disease of different aetiologies who received OLT demonstrated that amongst patients with depression prior to surgery, those taking antidepressants at the time of OLT experienced significantly less acute cellular rejection (13%) than depressed patients not receiving antidepressants (40%). 10 The group hypothesised that effective treatment of depression was associated with increased compliance with immunosuppressant medications. No difference in time to death or incidence of graft dysfunction was observed between depressed and nondepressed groups, consistent with other studies that have also failed to show that pre-operative depression per se is a risk factor for poor post-OLT outcome.…”

Liver Transplant—Psychiatric and Psychosocial Aspects

“…A study in which domains of anxiety and depression were combined, reported a diagnosis of adjustment disorder or depression in upto 36% of the patients awaiting liver transplantation. 44 Personality characteristics and coping abilities have been evaluated in patients waiting to undergo liver transplant. It has been seen that patients frequently have maladaptive coping styles with poor fighting spirit, anxious preoccupations, hopelessness, negation and fatalism being found frequently.…”