Pre-transplant Depression Is Associated with Length of Hospitalization, Discharge Disposition, and Survival After Liver Transplantation

Published in: PloS One, v. 11, no. 11, Nov. 2016, p. e0165517

Posted on RAND.org on November 30, 2016

by Shari Rogal, Gautham Mankaney, Viyan Udawatta, Matthew Chinman, Chester B. Good, Susan L. Zickmund, Klaus Bielefeldt, Alexis Chidi, Naudia Jonassaint, Alison Jazwinski, Obaid Shaikh, Christopher Hughes, Paulo Fontes, Abhinav Humar, Andrea DiMartini

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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.

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