title: Psychiatric Predictors of Long-term Transplant-Related Outcomes in Lung Transplant Recipients.
abstract: BACKGROUND
  Long-term survival after lung transplantation remains poor, yet modifiable risk factors for late-term morbidity and mortality have yet to be identified. Because psychiatric disorders increase risk for poor health outcomes in many nontransplant chronic disease populations, lung recipients with depression or anxiety before or early after transplantation may be at heightened risk for late-term transplant-related morbidity and mortality.
  
  
  METHODS
  Among 178 patients from a prospective study of mental health after lung transplantation, we identified 1-year survivors and examined whether they experienced major depression or anxiety disorders during that year as well as before transplantation. We used multivariable Cox regression to examine the relationship between these disorders and risk for subsequent bronchiolitis obliterans syndrome (BOS), mortality and graft loss for up to 15 years posttransplant, controlling for other known risk factors for the outcomes.
  
  
  RESULTS
  One hundred fifty-five recipients were studied. Recipients with posttransplant depression had an elevated risk of BOS (hazard ratio [HR], 1.91; 95% confidence interval [95% CI], 1.10-3.31), patient death (HR, 1.65; 95% CI, 1.01-2.71) and graft loss (HR, 1.75; 95% CI, 1.06-2.88). A trend toward reduced risk of BOS was observed in recipients with posttransplant anxiety (HR, 0.61; 95%CI, 0.37-1.00). Neither pretransplant disorder was related to risk for any outcome.
  
  
  CONCLUSIONS
  Early posttransplant depression increases risk for long-term transplant-related morbidity and mortality. Screening to identify depression should therefore be routine in posttransplant care. Although anxiety was not significantly associated with poor outcomes, screening for posttransplant anxiety should also be routine, to reduce patient distress. Research is needed to better understand mechanisms underlying depression-outcome associations.
authors.affiliation: 1 Department of Medicine, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA. 2 Departments of Psychiatry and Surgery, University of Pittsburgh, Pittsburgh, PA. 3 Department of Acute and Tertiary Care Nursing, School of Nursing, University of Pittsburgh, Pittsburgh, PA. 4 Department of Surgery, University of Pittsburgh, Pittsburgh, PA. 5 Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA. 6 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA. 7 Department of Surgery, Temple University, Philadelphia, PA. 8 Departments of Psychiatry, Psychology, Epidemiology, Biostatistics, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Rosenberger
authors.forename: Andrea F
authors.initials: AF
authors.lastname: DiMartini
authors.forename: Annette J
authors.initials: AJ
authors.lastname: DeVito Dabbs
authors.forename: Christian A
authors.initials: CA
authors.lastname: Bermudez
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Pilewski
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Toyoda
authors.forename: Mary Amanda
authors.initials: MA
authors.lastname: Dew
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000401:mortality / Q000523:psychology*; D001989:Bronchiolitis Obliterans / Q000175:diagnosis / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000401:mortality / Q000523:psychology*; D005260:Female; D006085:Graft Survival; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality / Q000523:psychology*; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010414:Pennsylvania / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017741:Survivors / Q000523:psychology*; D013997:Time Factors; D066027:Transplant Recipients / Q000523:psychology*; D016896:Treatment Outcome