Neurobehavioral functioning and survival following lung transplantation.
BACKGROUND
Neurobehavioral functioning is widely recognized as being an important consideration in lung transplant candidates, but little is known about whether these factors are related to clinical outcomes. The present study examined the relationship of neurobehavioral functioning, including measures of executive function and memory, depression, and anxiety, to long-term survival among lung transplant recipients.


METHODS
The sample was drawn from 201 patients who underwent transplantation at Duke University and Washington University who participated in a dual-site clinical trial investigating medical and psychosocial outcomes in transplant candidates with end-stage lung disease. All patients completed the Beck Depression Inventory-II (BDI-II) and Spielberger State-Trait Anxiety Inventory at baseline and again after 12 weeks, while a subset of 86 patients from Duke University also completed neurocognitive testing. Patients were followed for survival up to 12 years after completing baseline assessments.


RESULTS
One hundred eleven patients died over a mean follow-up of 10.8 years (SD=0.8). Baseline depression, anxiety, and neurocognitive function were examined as predictors of posttransplant survival, controlling for age, 6-min walk distance, FEV, and native disease; education and cardiovascular risk factors were also included in the model for neurocognition. Lower executive function (hazard ratio [HR]=1.09, P=.012) and memory performance (HR=1.11, P=.030) were independently associated with greater mortality following lung transplant. Although pretransplant depression and anxiety were not predictive of mortality, patients who scored>13 on the BDI-II at baseline and after 3 months pretransplant had greater mortality (HR=1.85 [95% CI, 1.04, 3.28], P=.036).


CONCLUSIONS
Neurobehavioral functioning, including persistently elevated depressive symptoms and lower neurocognitive performance, was associated with reduced survival after lung transplantation.


BACKGROUND
ClinicalTrials.gov; No.: NCT00113139; URL: www.clinicaltrials.gov.
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Duke University Health System, Durham, NC. Electronic address: patrick.j.smith@dm.duke.edu.
Patrick J
PJ
Smith
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Duke University Health System, Durham, NC.
James A
JA
Blumenthal
Washington University School of Medicine in St. Louis, St. Louis, MO.
Robert M
RM
Carney
Washington University School of Medicine in St. Louis, St. Louis, MO.
Kenneth E
KE
Freedland
College of Medicine, Drexel University, Philadelphia, PA.
C Virginia F
CVF
O'Hayer
Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Biostatistics, UNC Gillings School of Global Public Health, Chapel Hill, NC.
Elbert P
EP
Trulock
Department of Medicine, Duke University Medical Center, Duke University Health System, Durham, NC.
Tereza
T
Martinu
College of Medicine, Drexel University, Philadelphia, PA.
Todd A
TA
Schwartz
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Duke University Health System, Durham, NC.
Benson M
BM
Hoffman
College of Medicine, Drexel University, Philadelphia, PA.
Gary G
GG
Koch
Department of Surgery, Duke University Medical Center, Duke University Health System, Durham, NC.
R Duane
RD
Davis
Department of Medicine, Duke University Medical Center, Duke University Health System, Durham, NC.
Scott M
SM
Palmer
D000223:Adaptation, Psychological; D000328:Adult; D001519:Behavior / Q000502:physiology*; D003863:Depression / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008171:Lung Diseases / Q000601:surgery; D016040:Lung Transplantation / Q000401:mortality / Q000523:psychology*; D008297:Male; D008568:Memory / Q000502:physiology*; D008875:Middle Aged; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology