Background:

Elevated depressive symptoms have been associated with worse clinical outcomes following lung transplantation, including mortality. Few studies, however, have examined the mechanisms or clinical correlates of elevated depressive symptoms after transplant. Immunosuppressant (IS) medication nonadherence in particular has been postulated to mediate the depression and mortality association, given its critical importance to patient survival.

Methods:

We conducted a retrospective study of 271 patients who received a lung transplant between 2014 and 2016. Participants were primarily pulmonary fibrosis (n = 109 [40%]), but also included cystic fibrosis (n = 55 [20%]), COPD (n = 49 [18%]), and 'other' native diseases (sarcoidosis, primary pulmonary hypertension, Eisenmenger's, etc.). Depressive symptoms were assessed using the Center for Epidemiological Studies Depression inventory (CES-D) approximately 2 months following lung transplant in outpatient clinic. Serum IS levels and time to hospitalizations within 1 year post-transplant as well as mortality data were extracted from medical records. Individual IS target ranges were obtained at 3, 6, and, 9 months post-transplant; values were considered as out of range if they were below or above the ±3 point window for each target IS level.

Results:

Depressive symptoms were common following transplant (mean CES-D score = 8.3 [7.3]), with 16% of participants reporting clinically elevated levels (≥16). Depressive symptoms varied by native disease (P = .035), with higher levels in pulmonary fibrosis and 'other' participants, but were otherwise unrelated to background characteristics. Greater depressive symptoms were correlated with a higher percentage of out of range IS assessments (r = 0.14, P = .027). Both depressive symptoms and non-adherent IS levels were associated with greater mortality (HR = 1.45, P < .01; HR = 1.65, P < .01, respectively), and remained predictive in a multivariate model controlling for native disease, gender, and type of transplant (HR = 1.44, P < .01; 1.58, P < .01, respectively).

Conclusion:

Depressive symptoms are common following transplantation, may vary across native diseases, and are associated with greater non-adherent IS levels. Both depressive symptoms and IS non-adherence are predictive of adverse clinical outcomes.

CITATION INFORMATION: Chu M. C., Smith P. J., Stonerock G. L., Blumenthal J. A. Depressive Symptoms, Medication Nonadherence, and Clinical Outcomes Following Lung Transplantation Am J Transplant. 2017;17 (suppl 3).

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