title: Mental health disorders and solid-organ transplant recipients.
abstract: Depression affects up to 60% of solid-organ recipients and is independently associated with both mortality (hazard ratio for death of ~2) and de novo malignancy after transplantation, although the mechanism is not clear. Both pretransplantation psychosis and depression occurring more than 2 years after transplantation are associated with increased noncompliance and graft loss. It remains to be shown that effective treatment of depression is associated with improved outcomes and quality of life. Immunosuppressive drugs (especially corticosteroids and calcineurin inhibitors) and physiologic challenges can precipitate deterioration in mental health. All potential transplant candidates should be assessed for mental health problems and preexisting medical conditions that can mimic mental health problems, such as uremic, hepatic, or hypoxic encephalopathy, should be identified and treated appropriately. Expert mental health review of those with identified risk factors (such as previous suicide attempts, history of mental illness or noncompliance with medications) is advisable early in the transplant assessment process to mitigate risk and support the patient. Patients with mental health disorders, when adequately controlled and socially supported, have outcomes similar to the general transplant population. Therefore, exclusion from transplantation based on the diagnosis alone is neither ethically nor medically justified. However, it is ethically and clinically justifiable to deny access to transplantation to those who, despite full support, would have a quality of life that is unacceptable to the candidate or are likely to be noncompliant with treatment or follow-up, which would lead to graft loss.
authors.affiliation: 1 NIHR Birmingham Liver Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK. 2 Liver Unit, Queen Elizabeth Hospital, Birmingham, UK. 3 Organ Donation and Transplantation, NHS Blood and Transplant, Bristol, UK. 4 Address correspondence to: Chris Corbett, M.B.B.S., M.R.C.P., NIHR Birmingham Liver Biomedical Research Unit and Centre for Liver Research, University of Birmingham, 5th Floor IBR Building, Birmingham B152TT, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Corbett
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Armstrong
authors.forename: Richard
authors.initials: R
authors.lastname: Parker
authors.forename: Kerry
authors.initials: K
authors.lastname: Webb
authors.forename: James M
authors.initials: JM
authors.lastname: Neuberger
mesh_terms: D015897:Comorbidity; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects / Q000941:ethics / Q000401:mortality / Q000523:psychology*; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D008603:Mental Health / Q000941:ethics; D010349:Patient Compliance; D018579:Patient Selection / Q000941:ethics; D011788:Quality of Life; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents