Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA.
Albert Einstein Healthcare Network, Surgery, Philadelphia, Pennsylvania, USA.
Clin Transplant. 2022 Jun;36(6):e14669. doi: 10.1111/ctr.14669. Epub 2022 Apr 17.
There are higher rates of depression and suicidal ideation among those with chronic diseases, including end-stage renal disease, diabetes mellitus and liver disease. Suicide is the tenth leading cause of death worldwide and is more prevalent among transplant recipients. Although transplantation has the potential to improve quality of life, many transplant recipients commit suicide each year. The extent to which sex, race, age, type of insurance coverage, time on waitlist, comorbidities, immunosuppressive regimen and graft loss contribute to suicide risk in this population remains understudied.
We queried UNOS data collected between 1990 and 2019 to determine what risk factors contribute to suicide in the transplant population. Suicide mortality rate was calculated by determining the fraction of organ recipients who died by suicide since 1990 and was expressed as deaths per 100 000. Two groups (suicide and all other cause mortality) were compared via univariate and multivariate statistical analysis. Time to graft loss was estimated using a Kaplan Meier Product Limit method. A propensity score analysis was performed to match patients who committed suicide to those who did not, allowing us to balance the relatively small sample of size of the suicide cohort with the larger all other cause mortality group to minimize the effect of confounding variables. We estimated years of organ life lost using the restricted mean. Statistical significance was defined by p < .05.
The data included 135 432 transplant deaths in total; the majority were kidney recipients-82 305 (61%). We determined suicide rates of .28%, .31%, and .44% for kidney, liver and pancreas, respectively, with an overall rate of .3%. Across all three organs the most significant risk factor was male sex. Non-Hispanic whites were also at elevated risk (OR = 2.16, p < .003). In the liver and kidney transplant groups, the odds of committing suicide were reduced by 4% with advancing age. The odds of taking one's own life was inversely related to BMI in the kidney and pancreas groups. We observed a doubling of suicide rates from .3% in 2014 to .6% in 2018. There were no other statistically significant correlations.
Suicide is more prevalent among transplant recipients than in the general population. White males in particular are most at risk. The highest rate of suicide was in pancreas recipients. Advancing age and increasing BMI conferred some protective effect. There were no significant associations between suicide incidence and glucocorticoid use, type of insurance coverage, time on waitlist or graft loss. The phenomenon has become more prevalent in recent years.
患有慢性疾病（包括终末期肾病、糖尿病和肝病）的人群中，抑郁和自杀意念的发生率更高。自杀是全球第十大死因，在器官移植受者中更为普遍。尽管移植有改善生活质量的潜力，但每年仍有许多移植受者自杀。在该人群中，性别、种族、年龄、保险类型、等待名单时间、合并症、免疫抑制方案和移植物丢失等因素对自杀风险的影响程度仍有待研究。
我们查询了 1990 年至 2019 年期间 UNOS 收集的数据，以确定哪些风险因素导致移植人群的自杀。通过确定自 1990 年以来因自杀而死亡的器官接受者的比例来计算自杀死亡率，并用每 10 万人中的死亡人数表示。通过单变量和多变量统计分析比较自杀死亡率组和所有其他死因死亡率组。使用 Kaplan-Meier 乘积限法估计移植物丢失时间。进行倾向评分分析以匹配自杀患者和未自杀患者，使我们能够平衡自杀队列相对较小的样本量和较大的所有其他死因死亡率组，以最大程度地减少混杂变量的影响。我们使用受限均值估计器官寿命损失年数。p 值<0.05 被定义为具有统计学意义。
数据共包括 135432 例移植死亡，其中大多数是肾脏接受者-82305 例（61%）。我们确定了肾脏、肝脏和胰腺的自杀率分别为 0.28%、0.31%和 0.44%，总体自杀率为 0.3%。在所有三个器官中，最重要的风险因素是男性。非西班牙裔白人也处于较高风险（OR=2.16，p<0.003）。在肝和肾移植组中，随着年龄的增长，自杀的可能性降低了 4%。在肾脏和胰腺组中，BMI 越低，自杀的可能性越低。我们观察到，2014 年自杀率为 0.3%，2018 年自杀率上升至 0.6%，自杀率翻了一番。没有其他具有统计学意义的相关性。
移植受者的自杀率高于一般人群。特别是白人男性的风险最高。胰腺接受者的自杀率最高。年龄增长和 BMI 增加提供了一些保护作用。自杀发生率与糖皮质激素使用、保险类型、等待名单时间或移植物丢失之间无显著关联。近年来，这种现象变得更加普遍。
