Early Trajectories of Depressive Symptoms after Liver Transplantation for Alcoholic Liver Disease Predicts Long-Term Survival

Authors

  • A. DiMartini,

    Corresponding author
    1. Department of Psychiatry, University of Pittsburgh Medical Center, PA
    2. Department of Transplantation Surgery, University of Pittsburgh Medical Center, PA
    3. University of Pittsburgh Medical Center, PA
    4. The University of Pittsburgh Medical School, PA
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  • M. A. Dew,

    1. Department of Psychiatry, University of Pittsburgh Medical Center, PA
    2. Department of Psychology, University of Pittsburgh Medical Center, PA
    3. Department of Epidemiology, University of Pittsburgh Medical Center, PA
    4. Department of Biostatistics, University of Pittsburgh Medical Center, PA
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  • D. Chaiffetz,

    1. The University of Pittsburgh Medical School, PA
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  • M. G. Fitzgerald,

    1. Department of Psychiatry, University of Pittsburgh Medical Center, PA
    2. University of Pittsburgh Medical Center, PA
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  • M. E. deVera,

    1. Department of Transplantation Surgery, University of Pittsburgh Medical Center, PA
    2. University of Pittsburgh Medical Center, PA
    3. The University of Pittsburgh Medical School, PA
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  • P. Fontes

    1. Department of Transplantation Surgery, University of Pittsburgh Medical Center, PA
    2. University of Pittsburgh Medical Center, PA
    3. The University of Pittsburgh Medical School, PA
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  • This research is funded by grant nos. K23 AA0257 from the National Institute of Alcohol Abuse and Alcoholism and R01 DK066266 from the National Institute of Digestive Disorders and Kidney Diseases Rockville, MD, USA.

  • This publication was made possible by grant number 5UL1 RR024153-04 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. Information on NCRR is available at http://www.ncrr.nih.gov.

Corresponding author: Andrea DiMartini, dimartiniaf@upmc.edu

Abstract

Although it is well known that depression is associated with poorer medical outcomes, the association between depression- and liver transplant (LTX)-specific outcomes has not been investigated. We identified three trajectories of depressive symptoms evolving within the first post-LTX year in a cohort of 167 patients transplanted for alcoholic cirrhosis: a group with consistently low depression levels at all time points (group 1, n = 95), a group with initially low depression levels that rose over time (group 2, n = 41), and a group with consistently high depression levels (group 3, n = 31). Controlling for medical factors associated with poorer survival, recipients with increasing depression or persisting depression were more than twice as likely to die (all cause mortality) within the subsequent years. At 10 years post-LTX the survival rate was 66% for the low depression group, but only 46% and 43%, respectively, for the increasing depression and high depression groups. Except for a paradoxically higher percentage of malignancies in the low depression group, the causes of death and other specific LTX outcomes were not different between groups. Whether treatment of depression will improve survival rates is an area for research.

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