Department of Internal Medicine, Cedars-Sinai Medical Center, Los, Angeles, CA, USA.
Department of Cardiology, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA.
Clin Transplant. 2021 Mar;35(3):e14204. doi: 10.1111/ctr.14204. Epub 2021 Jan 5.
Depression is prevalent in patients with heart failure and after heart transplant. We identified the prevalence of pre- and post-transplant depression and its association with clinical characteristics and post-transplant outcomes.
We reviewed 114 adults transplanted 1/1/2015 to 12/31/2015 and identified patients with pre- and post-transplant depression. Clinical characteristics and outcomes were compared.
Of 114 patients, 35.1% had pre-transplant depression and 26.3% had post-transplant depression. Patients with post-transplant depression within the first year were significantly more likely to have acute rejection (10% vs 0%), longer intensive care unit (11.7 days vs 7.8 days) and hospital stay (31.7 days vs 16.3 days), and discharge to inpatient rehabilitation (26.7% vs 8.3%). Patients with post-transplant depression within the first year had significantly higher 5-year mortality (30% vs 9.5%, p = .009). However, after adjustment for total artificial heart/biventricular assist device, acute rejection, intensive care unit, and hospital length of stay, this relationship was no longer significant (HR 2.11; 95% CI 0.18-25.27; p = .556).
Depression is common among heart transplant candidates and recipients. While pre-transplant depression did not impact outcomes, patients with post-transplant depression were more likely to have had a complicated course, suggesting the need for increased vigilance regarding depression in such patients.
抑郁症在心力衰竭患者和心脏移植后较为普遍。我们确定了移植前和移植后抑郁症的患病率及其与临床特征和移植后结局的关系。
我们回顾了 2015 年 1 月 1 日至 2015 年 12 月 31 日期间接受心脏移植的 114 名成年人，并确定了有移植前和移植后抑郁症的患者。比较了临床特征和结局。
在 114 名患者中，35.1%有移植前抑郁症，26.3%有移植后抑郁症。在移植后第一年出现抑郁症的患者更有可能发生急性排斥反应（10%比 0%）、更长的重症监护病房（11.7 天比 7.8 天）和住院时间（31.7 天比 16.3 天），以及出院到住院康复（26.7%比 8.3%）。在移植后第一年出现抑郁症的患者 5 年死亡率显著更高（30%比 9.5%，p=0.009）。然而，在校正全人工心脏/双心室辅助装置、急性排斥反应、重症监护病房和住院时间后，这种关系不再显著（HR 2.11；95%CI 0.18-25.27；p=0.556）。
抑郁症在心脏移植候选人和受者中很常见。虽然移植前抑郁症不会影响结局，但移植后出现抑郁症的患者更有可能经历复杂的病程，这表明需要对这些患者的抑郁症提高警惕。
