title: Depressive symptoms predict long-term mortality after liver transplantation.
abstract: OBJECTIVE
  Depressive symptoms are common after liver transplantation (LT). We studied whether depressive symptoms affect long-term survival after LT.
  
  
  METHODS
  In a prospective cohort study, 134 liver transplant patients were assessed for depressive symptoms using the Beck Depression Inventory-short form (BDI), focusing on the 3 months post-LT score and on the score change from the waiting list period. They were followed up for long-term survival. The median duration of the follow-up period was 43 months post-LT. None of the 134 patients was lost to follow-up for survival.
  
  
  RESULTS
  A total of 33.6% of the LT patients had mild to moderate depressive symptoms 3 months post-LT. Eighteen (13.4%) patients died during the follow-up. Using Cox proportional hazards analysis, depressive symptoms were significantly associated with mortality (hazard ratio [HR] 1.22, 95% confidence interval (CI) 1.07-1.40, P<.003), one more point in the BDI score being associated with a 17% increase in mortality risk. Other predictive factors of mortality were older age and hepatitis C virus with recurrence 3 months post-LT. Similarly, an increase in depressive symptoms between the waiting list and 3 months post-LT periods predicted mortality (HR 1.18, 95% CI 1.01-1.38, P=.03), especially for patients without depressive symptoms on waiting list (HR 1.56, 95% CI 1.16-2.12, P=.004).
  
  
  CONCLUSIONS
  Depressive symptoms after LT and an increase in depressive symptoms between the waiting list and post-LT are associated with an increased risk of long-term mortality. Interventions that could reduce depressive symptoms could potentially decrease long-term mortality after LT.
authors.affiliation: INSERM U 669, Paris XI University, Psychiatry Department, Bicêtre University Hospital, Assistance Publique—Hopitaux de Paris, Paris, France. emmanuelle.corruble@bct.aphp.fr
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Corruble
authors.forename: Caroline
authors.initials: C
authors.lastname: Barry
authors.forename: Isabelle
authors.initials: I
authors.lastname: Varescon
authors.forename: Bruno
authors.initials: B
authors.lastname: Falissard
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
authors.forename: Didier
authors.initials: D
authors.lastname: Samuel
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003863:Depression / Q000401:mortality / Q000523:psychology*; D005260:Female; D016174:Hepacivirus; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012008:Recurrence