Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, United States; Department of Transplantation, Mayo Clinic, Jacksonville, FL, United States.
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States; William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN, United States.
J Psychosom Res. 2018 Aug;111:27-35. doi: 10.1016/j.jpsychores.2018.05.005. Epub 2018 May 17.
This study evaluated the impact of psychiatric comorbidities in liver transplant (LT) recipients aged ≥65 years (elderly) on length of hospital-stay (LOS), death, and a composite outcome of graft loss or death.
This retrospective study assessed impact of psychiatric comorbidities in 122 elderly LT recipients and a matched group of 122 LT recipients aged <65 years (younger). Associations were assessed using adjusted multivariable regression models.
Among elderly, median age at LT was 68 years, most were males (62%), white (85%) and 61.7% had a history of any psychiatric diagnosis. Among younger, median age was 55, most were males (67.2%), white (77.5%) and 61.5% had any psychiatric diagnosis. Median LOS was 8 days for both groups. Among elderly, after a median follow-up of 5 years, 25.4% died and 29.5% experienced graft loss or death. History of adjustment disorder, history of depression, past psychiatric medication use, and pain prior to LT were associated with an increased risk of death or the composite graft loss or death. Perioperative use of SSRIs and lack of sleeping medication use were associated with longer LOS. Among aged <65, after median follow-up of 4.7 years, 21 patients (17%) died and 25 (20%) experienced graft loss or death; history of depression, perioperative SSRIs or sleeping medications use was associated with increased mortality and graft-loss or death.
Six out of 10 patients among both elderly and younger cohorts had pre-LT psychiatric comorbidities, some of which adversely affected outcomes after LT.
本研究评估了≥65 岁（老年）肝移植（LT）受者合并精神疾病对住院时间（LOS）、死亡以及移植物丢失或死亡复合终点的影响。
本回顾性研究评估了 122 例老年 LT 受者和 122 例年龄<65 岁（年轻）LT 受者合并精神疾病的影响。采用调整后的多变量回归模型评估相关性。
在老年组中，LT 时的中位年龄为 68 岁，大多数为男性（62%），白种人（85%），61.7%有任何精神科诊断史。在年轻组中，中位年龄为 55 岁，大多数为男性（67.2%），白种人（77.5%），61.5%有任何精神科诊断史。两组的 LOS 中位数均为 8 天。在老年组中，中位随访 5 年后，25.4%死亡，29.5%发生移植物丢失或死亡。调整障碍史、抑郁史、既往精神科药物使用史和 LT 前疼痛与死亡或移植物丢失或死亡复合终点风险增加相关。围手术期使用 SSRI 和缺乏睡眠药物与 LOS 延长相关。在年龄<65 岁的患者中，中位随访 4.7 年后，21 例（17%）死亡，25 例（20%）发生移植物丢失或死亡；抑郁史、围手术期使用 SSRI 或睡眠药物与死亡率和移植物丢失或死亡增加相关。
在老年和年轻两组患者中，每 10 例患者中有 6 例有 LT 前精神疾病合并症，其中一些对 LT 后结局产生不利影响。
