Early post-transplant medical compliance and mental health predict physical morbidity and mortality one to three years after heart transplantation.
BACKGROUND
Poor medical compliance has been held responsible for a large proportion of deaths occurring subsequent to initial postoperative recovery. However, beyond clinical reports, there has been little empirical examination of this issue, or of the extent to which major psychiatric disorder and failure to adjust to the transplant predict long-term physical morbidity and mortality. We prospectively examined whether a full range of compliance behaviors and psychiatric outcomes during the first year post-transplant predicted subsequent mortality and physical morbidity through 3 years post-transplant.


METHODS
A total of 145 heart recipients who had received detailed compliance and mental health assessments during the first year post-transplant were followed up at 3 years post-transplant. Interview data and corroborative information from family members were used to determine compliance in multiple domains, psychiatric diagnoses, and psychiatric symptomatology during the first year post-surgery. Medical record reviews were performed to abstract data on acute graft rejection episodes, incident cardiac allograft disease (CAD) and mortality from 1 to 3 years post-transplant.


RESULTS
After controlling for known transplant-related predictors of outcome, multivariate analyses yielded the following significant (p < 0.05) results: (a) risk of acute graft rejection was 4.17 times greater among recipients who were not compliant with medications; (b) risk of incident CAD was elevated by persistent depression (Odds Ratio, OR = 4.67), persistent anger-hostility (OR = 8.00), medication noncompliance (OR = 6.91), and obesity (OR = 9.92); and (c) risk of mortality was increased if recipients met criteria for Post-Traumatic Stress Disorder related to the transplant (OR = 13.74).


CONCLUSIONS
The findings, plus data we have previously reported that showed which patients are most likely to have compliance and psychiatric problems early post-transplant, suggest that interventions focused on maximizing patients' psychosocial status in these areas may further improve long-term physical health outcomes in this population.
Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, Pennsylvania 15213, USA. DEW1@vms.cis.pitt.edu
M A
MA
Dew
R L
RL
Kormos
L H
LH
Roth
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S
Murali
A
A
DiMartini
B P
BP
Griffith
D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000401:mortality / Q000523:psychology*; D015331:Cohort Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000401:mortality / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010349:Patient Compliance / Q000523:psychology*; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000523:psychology*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000401:mortality / Q000523:psychology*; D015996:Survival Rate