Pre-Transplant Depression Is Associated with Length of Hospitalization, Discharge Disposition, and Survival after Liver Transplantation.
Depression after liver transplantation has been associated with decreased survival, but the effects of pre-transplant depression on early and late post-transplant outcomes remain incompletely evaluated. We assessed all patients who had undergone single-organ liver transplantation at a single center over the prior 10 years. A diagnosis of pre-transplant depression, covariates, and the outcomes of interest were extracted from the electronic medical record. Potential covariates included demographics, etiology and severity of liver disease, comorbidities, donor age, graft type, immunosuppression, and ischemic times. In multivariable models adjusting for these factors, we evaluated the effect of pre-transplant depression on transplant length of stay (LOS), discharge disposition (home vs. facility) and long-term survival. Among 1115 transplant recipients with a median follow-up time of 5 years, the average age was 56±11 and MELD was 12±9. Nineteen percent of the study population had a history of pre-transplant depression. Pre-transplant depression was associated with longer LOS (median = 19 vs. 14 days, IRR = 1.25, CI = 1.13,1.39), discharge to a facility (36% vs. 25%, OR 1.70,CI = 1.18,2.45), and decreased survival (HR = 1.54,CI = 1.14,2.08) in this cohort, accounting for other potential confounders. In conclusion, pre-transplant depression was significantly associated with longer transplant length of stay, discharge to a facility, and mortality in this cohort.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America.|Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America.|Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States of America.
Shari S
SS
Rogal
Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America.
Gautham
G
Mankaney
Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America.
Viyan
V
Udawatta
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America.|Rand Corporation, Pittsburgh, PA, United States of America.
Matthew
M
Chinman
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America.|Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America.
Chester B
CB
Good
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America.|Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America.
Susan
S
Zickmund
Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States of America.
Klaus
K
Bielefeldt
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America.|Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America.
Alexis
A
Chidi
Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States of America.
Naudia
N
Jonassaint
Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States of America.
Alison
A
Jazwinski
Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America.|Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States of America.
Obaid
O
Shaikh
Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America.
Christopher
C
Hughes
Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America.
Paulo
P
Fontes
Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America.
Abhinav
A
Humar
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States of America.
Andrea
A
DiMartini
D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D007902:Length of Stay; D016031:Liver Transplantation / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome