title: Posttransplantation Outcomes in Veterans With Serious Mental Illness.
abstract: BACKGROUND
  Anticipating poor recovery due to impaired self-management and appointment-keeping, clinicians may consider serious mental illness (SMI) a significant concern in organ transplantation. However, little empirical evidence exists regarding posttransplantation outcomes for patients with SMI.
  
  
  METHODS
  This study analyzed health services data to evaluate posttransplantation 3-year survival by SMI status in a nationwide cohort of patients in the Veterans Health Administration (VHA).
  
  
  RESULTS
  A total of 960 recipients of solid organ or bone marrow transplants were identified from Veterans Health Administration administrative data extracts for fiscal years 2006 to 2009. Of these, 164 (17%) had an SMI diagnosis before transplantation (schizophrenia, posttraumatic stress, major depressive, and bipolar disorders); 301 (31%) had some other mental illness diagnosis (such as anxiety, adjustment reactions, or substance abuse); and 495 (52%) had no mental health diagnosis. Twenty-two patients (2%) required retransplantation and 208 patients (22%) died during follow-up. Data on whether these were primary or repeat transplantations were unavailable. Rates of attendance at postoperative outpatient visits and number of months for which immunosuppressive drugs fills were recorded were similar among mental illness groups, as were rates of diagnosed immunological rejection. Three-year mortality was equivalent among mental health groups: no mental health (19%) versus other mental illness (23%) versus SMI (27%; χ(2) = 5.11; df = 2; P = .08). In adjusted survival models, no effect of mental health status was observed.
  
  
  CONCLUSIONS
  Serious mental illness diagnosis does not appear to be associated with adverse transplantation outcomes over the first 3 years; however, a potentially diverging survival curve may portend higher mortality at 5 years.
authors.affiliation: 1 Central Texas Veterans Health Care System, Department of Veterans Affairs, Temple, TX. 2 Texas A&M Health Science Center, College of Medicine, Temple, TX. 3 Center for Applied Health Research, Central Texas Veterans Health Care System jointly with Baylor Scott & White Health, Temple, TX. 4 Department of Veterans Affairs VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX. 5 South Texas Veterans Health Care System, Department of Veterans Affairs, San Antonio, TX. 6 UT Health Science Center San Antonio, San Antonio TX. 7 Baylor Scott & White Health, Temple TX.
authors.forename: Lianna D
authors.initials: LD
authors.lastname: Evans
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Stock
authors.forename: John E
authors.initials: JE
authors.lastname: Zeber
authors.forename: Sandra B
authors.initials: SB
authors.lastname: Morissette
authors.forename: Andrea A
authors.initials: AA
authors.lastname: MacCarthy
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Sako
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Lappin
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Lawrence
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: MacCarthy
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Copeland
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000401:mortality / Q000523:psychology*; D016009:Chi-Square Distribution; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D055118:Medication Adherence; D001523:Mental Disorders / Q000175:diagnosis / Q000401:mortality / Q000523:psychology*; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D016377:Organ Transplantation / Q000009:adverse effects / Q000401:mortality / Q000523:psychology*; D010342:Patient Acceptance of Health Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology*; D058014:Veterans Health
chemical_list: D007166:Immunosuppressive Agents