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Depression and Anxiety as Risk Factors for Morbidity and Mortality After Organ Transplantation

2015; Wolters Kluwer; Volume: 100; Issue: 5 Linguagem: Inglês

10.1097/tp.0000000000000901

1534-6080

Mary Amanda Dew, Emily M. Rosenberger, Larissa Myaskovsky, Andrea F. DiMartini, Annette DeVito Dabbs, Donna M. Posluszny, Jennifer L. Steel, Galen E. Switzer, Diana A. Shellmer, Joel B. Greenhouse,

Palliative Care and End-of-Life Issues

In Brief Background 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. Methods 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. Results 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). Conclusions 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. Using a systematic review and meta-analysis about depression and anxiety in solid organ transplant recipients, the authors conclude that depression, but not anxiety, increases the risk for posttransplant mortality, suggesting this condition must be screened for and treated.