Depression and Anxiety as Risk Factors for Morbidity and Mortality After Organ Transplantation: A Systematic Review and Meta-Analysis.
Depression and anxiety are common mental health problems in transplant populations. There is mixed evidence concerning whether they increase morbidity and mortality risks after transplantation. If such associations exist, additional risk reduction strategies may be needed.



Four bibliographic databases were searched from 1981 through September 2014 for studies prospectively examining whether depression or anxiety (determined with diagnostic evaluations or standardized symptom scales) affected risk for posttransplant mortality, graft loss, acute graft rejection, chronic rejection, cancer, infection, and rehospitalization.



Twenty-seven studies (10 heart, total n = 1738; 6 liver, n = 1063; 5 kidney, n = 49515; 4 lung, n = 584; 1 pancreas, n = 80; 1 mixed recipient sample, n = 205) were identified. In each, depression and/or anxiety were typically measured before or early after transplantation. Follow-up for outcomes was a median of 5.8 years (range, 0.50-18.0). Depression increased the relative risk (RR) of mortality by 65% (RR, 1.65; 95% confidence interval [95% CI], 1.34-2.05; 20 studies). Meta-regression indicated that risk was stronger in studies that did (vs did not) control for potential confounders (P = .032). Risk was unaffected by type of transplant or other study characteristics. Depression increased death-censored graft loss risk (RR, 1.65; 95% CI, 1.21-2.26, 3 studies). Depression was not associated with other morbidities (each morbidity was assessed in 1-4 studies). Anxiety did not significantly increase mortality risk (RR, 1.39; 95% CI, 0.85-2.27, 6 studies) or morbidity risks (assessed in single studies).



Depression increases risk for posttransplant mortality. Few studies considered morbidities; the depression-graft loss association suggests that linkages with morbidities deserve greater attention. Depression screening and treatment may be warranted, although whether these activities would reduce posttransplant mortality requires study.
1 Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA. 2 Department of Psychology, University of Pittsburgh, Pittsburgh, PA. 3 Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA. 4 Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA. 5 Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA. 6 Department of Medicine, University of Pittsburgh, Pittsburgh, PA. 7 Center for Health Equity Research and Promotion, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, PA. 8 Department of Surgery, University of Pittsburgh, Pittsburgh, PA. 9 Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA. 10 Department of Statistics, Carnegie Mellon University, Pittsburgh, PA.
Mary Amanda
MA
Dew
Emily M
EM
Rosenberger
Larissa
L
Myaskovsky
Andrea F
AF
DiMartini
Annette J
AJ
DeVito Dabbs
Donna M
DM
Posluszny
Jennifer
J
Steel
Galen E
GE
Switzer
Diana A
DA
Shellmer
Joel B
JB
Greenhouse
D001007:Anxiety / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology; D003141:Communicable Diseases / Q000401:mortality; D003863:Depression / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology; D005260:Female; D006084:Graft Rejection / Q000401:mortality; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000401:mortality; D016017:Odds Ratio; D016377:Organ Transplantation / Q000009:adverse effects / Q000401:mortality*; D010359:Patient Readmission; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome