Depressive Symptoms, Exercise Capacity, and Clinical Outcomes After Lung Transplantation. Issue 4 (May 2018)

• Record Type: Journal Article
• Authors: Smith, Patrick J.; Byrd, Rebecca; Lusby, Megan; Clausen, Emily; Snyder, Laurie D.
• Is Part Of: Psychosomatic medicine. Volume 80:Issue 4(2018)
• Publication Date: 2018-05
• Subjects: CLAD -- depression -- exercise capacity -- lung transplantation -- mortality -- 6MWD = 6-minute walk distance -- CESD = Centers for Epidemiologic Study of Depression Scale -- CF = cystic fibrosis -- CLAD = chronic lung allograft dysfunction -- COPD = chronic obstructive pulmonary disease -- FEV1 = forced expiratory volume in 1 second -- HR = hazard ratio -- IQR = interquartile range -- LOS = length of stay -- PF = pulmonary fibrosis; Medicine, Psychosomatic -- Periodicals; 616.0805
• DOI: 10.1097/PSY.0000000000000573
• Languages: English
• ISSNs: 0033-3174

Abstract

ABSTRACT: Objective: Depressive symptoms are common among lung transplant recipients and have been associated with worse clinical outcomes. However, few studies have examined the association between depressive symptoms assessed at multiple time points or behavioral mechanisms by which posttransplant depressive symptoms may confer greater clinical risk. We therefore examined the associations between depressive symptoms, exercise capacity, chronic lung allograft dysfunction (CLAD), and mortality prospectively in a large sample of lung transplant recipients. Methods: Between July 2009 and February 2016, 251 lung transplant recipients were assessed before transplantation and again approximately 3 weeks and 3 months after transplant. Depressive symptoms were assessed using the Centers for Epidemiologic Studies of Depression scale. Functional exercise capacity was assessed using the 6-minute walk test. Cox proportional hazards models were used to examine the associations between depressive symptoms, exercise capacity, CLAD, and mortality. Results: During a median (range) follow-up of 4.5 (0.1 to 6.3) years, 53 participants (21%) died. Greater depressive symptoms (hazard ratio [HR] = 1.39 [95% CI = 1.05 to 1.84], p = .021) and poorer exercise capacity (HR = 0.58 [95% CI = 0.38 to 0.90], p = .021) assessed 3 months after transplant were both independently associated with mortality. Although greater depressive symptoms were associated with lower exercise capacity (β = −0.14, p = .039), exercise capacity did not mediate the association between depressive symptoms and mortality. In secondary analyses, depressive symptoms were independently predictive of CLAD (HR = 1.29 [95% CI = 1.01 to 1.65], p = .045) and the composite outcome of CLAD and mortality in a clustered event model (HR = 1.30 [1.09 to 1.56], p = .005). Conclusions: Depressive symptoms are associated with mortality and CLAD after lung transplantation, independent of exercise capacity. Abstract : Supplemental digital content is available in the text.