The Impact of Mental Health on Transplant Outcomes


By Ramsey Hachem, M.D.

Washington University School of Medicine Barnes-Jewish Hospital
Division of Pulmonary and Critical Care

Updated February 1, 2016

Lung transplantation improves survival for many patients with advanced lung disease. Furthermore, transplantation improves quality of life for most patients. In addition, mental health problems including depression and anxiety are common among patients with end-stage lung disease. Many are depressed because their health status has a negative impact on their ability to work and their activities of daily living. Others feel that their poor health may be a burden on their family, and most are anxious about the progression of their lung disease and its impact on their life and the lives of their family members. Anxiety, in particular, is a frequent mental health disorder after transplantation. Many patients are anxious about complications that might arise after transplantation and the complexity of their medical regimen. In addition, some patients experience post-traumatic stress disorder (PTSD). However, there has been a limited number of clinical studies that have examined the impact of mental health problems on outcomes after transplantation and few studies have explored potential treatments that might ameliorate their negative impact on quality of life.

A recent study that pooled data from numerous smaller studies that included recipients of all solid-organ transplants demonstrated an increased risk of death associated with depression that occurred either before or after transplantation. On the other hand, no association was found between anxiety and survival after transplantation. In addition, none of the studies examined whether the combination of anxiety and depression had a synergistic effect on survival or other post-transplant outcomes. Interestingly, neither depression nor anxiety appears to be associated with an increased risk of common complications after transplantation. For example, depression was not associated with an increased risk of acute or chronic rejection among heart transplant recipients or infections or re-admission to the hospital among liver transplant recipients. Similarly, anxiety did not increase the risk of acute or chronic rejection or post-transplant malignancies. However, few studies have examined the impact of mental health problems on morbidity specifically in lung transplant recipients. Nonetheless, it is clear that depression and anxiety have a significant impact on patients’ quality of life after transplantation.

The lack of association between mental health problems and specific morbidities after transplantation such as acute or chronic rejection or infections raises the question of how depression might impact survival after transplantation. It is noteworthy, that this association has been identified in other chronic disease states such as congestive heart failure and cancer outside of transplantation, but the exact mechanism is unclear. Depression may lead to poor lifestyle behaviors such as a poor diet and a sedentary lifestyle. Depression is also associated with an increased risk of substance abuse. Furthermore, depression may impact adherence to a complex medical regimen. Depressed patients may feel socially isolated, and this has been linked to mortality in the general population. Beyond its impact on behavior, depression may also exert a negative physiologic effect on cardiovascular health.

Perhaps equally important to their impact on survival is the effect of mental health problems on quality of life after transplantation. This in and of itself merits attention and treatment. Indeed, depression and anxiety are treatable disorders although comprehensive treatment sometimes requires a combination of pharmacotherapy and counseling. However, the impact of treatment of mental health disorders on the increased risk of mortality after transplantation is not known. It is reasonable to assume that many transplant recipients included in studies that demonstrate an increased mortality associated with depression were being treated. This raises questions about the efficacy of treatment and whether inadequately treated depression may have a larger impact on survival. Clearly, these issues need to be addressed in future clinical studies. Nonetheless, it is important for clinicians to screen for depression and anxiety and for patients suffering from mental health problems to seek medical attention. Although the treatment may be complex, there are various therapeutic options and identifying the problem is the first step.


Dew MA, et al. Depression and anxiety as risk factors for morbidity and mortality after organ transplantation: a systematic review and meta-analysis. Transplantation 2015 Oct 21 [Epub ahead of print].