Fadlallah Jad, Shah Vishva, Samudio Ana, Blydt-Hansen Tom, Mucsi Istvan
Ajmera Transplant Center, Division of Nephrology, University Health Network, Toronto, ON M5G 2N2, Canada.
Division of Nephrology, Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 3V4, Canada.
J Clin Med. 2025 Jul 11;14(14):4920. doi: 10.3390/jcm14144920.
Solid Organ Transplant Recipients (SOTRs) face an elevated risk of Sars-CoV-2 infection and poor outcomes if they contract the infection. This can induce or exacerbate anxiety and depressive symptoms. We used the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety (A) and Depression (D) scores to conduct a repeated cross-sectional ("pseudo-longitudinal") comparison of SOTRs' anxiety and depressive symptoms before and after the COVID-19 pandemic onset. This secondary analysis used cross-sectional data from a convenience sample of adult SOTRs (kidney, kidney-pancreas, and liver) recruited between 2016 and 2024. The exposure was categorized as follows: "Pandemic Experience" was categorized as PRE (pre-pandemic reference; transplanted and anxiety and depressive symptoms assessed pre-pandemic onset), POST-1 (transplanted before and assessed after onset), and POST-2 (transplanted and assessed after onset). The outcomes were PROMIS-A and PROMIS-D scores. The differences were assessed using multivariable linear regression-estimated means. Of the 816 participants, 588 (72%) were PRE, 135 (17%) were POST-1, and 93 (11%) were POST-2. In the fully adjusted model, the POST-2 group had significantly higher PROMIS-A scores (more severe symptoms) compared with PRE (adjusted mean [95% CI]: 54.2 [52.3; 56.1] vs. 51.7 [50.9; 52.4], = 0.02). The proportion of patients with potentially clinically significant anxiety was also higher in the POST-2 group, compared with PRE (OR [95%CI] 1.59 [1.0; 2.5]). The PROMIS-A scores were similar between PRE and POST-1, and between POST-1 and POST-2. The PROMIS-D scores were not different across the exposure groups. SOTRs transplanted after the pandemic onset experienced more anxiety but similar depression symptoms compared with pre-pandemic levels. Future research should explore mental health support for SOTRs during crisis situations involving infectious risk.
实体器官移植受者（SOTRs）感染新型冠状病毒2（Sars-CoV-2）的风险较高，且感染后预后较差。这可能会诱发或加重焦虑和抑郁症状。我们使用患者报告结局测量信息系统（PROMIS）焦虑（A）和抑郁（D）评分，对新冠疫情爆发前后SOTRs的焦虑和抑郁症状进行了重复横断面（“伪纵向”）比较。这项二次分析使用了2016年至2024年间招募的成年SOTRs（肾脏、肾胰腺和肝脏）便利样本的横断面数据。暴露情况分类如下：“疫情经历”分为疫情前（PRE，疫情前对照；移植且在疫情爆发前评估焦虑和抑郁症状）、疫情后1（疫情爆发前移植且在疫情爆发后评估）和疫情后2（疫情爆发后移植且在疫情爆发后评估）。结局指标为PROMIS-A和PROMIS-D评分。使用多变量线性回归估计均值评估差异。在816名参与者中，588名（72%）为PRE，135名（17%）为POST-1，93名（11%）为POST-2。在完全调整模型中，与PRE相比，POST-2组的PROMIS-A评分显著更高（症状更严重）（调整后均值[95%置信区间]：54.2[52.3；56.1]对51.7[50.9；52.4]，P = 0.02）。与PRE相比，POST-2组中具有潜在临床显著焦虑的患者比例也更高（比值比[95%置信区间]1.59[1.0；2.5]）。PRE与POST-1之间以及POST-1与POST-2之间的PROMIS-A评分相似。各暴露组的PROMIS-D评分没有差异。与疫情前水平相比，疫情爆发后接受移植的SOTRs经历了更多焦虑，但抑郁症状相似。未来的研究应探索在涉及感染风险的危机情况下为SOTRs提供心理健康支持。
