Anxiety and mood (대한불안의학회지)

Korean Academy of Anxiety Disorders (대한불안의학회)
권호 표지
DOI QR코드

DOI QR Code

Mental Health Issues in Solid-Organ Transplant Recipients; Pre-, Peri-, and Post-Transplant Phases

고형장기이식 환자의 정신건강: 이식의 시기별 이슈

  • Yeonjin Jung (Institute of Behavioral Science in Medicine, Yonsei University College of Medicine) ;
  • Jee In Kang (Institute of Behavioral Science in Medicine, Yonsei University College of Medicine)
  • 정연진 (연세대학교 의과대학 의학행동과학연구소) ;
  • 강지인 (연세대학교 의과대학 의학행동과학연구소)
  • Received : 2023.10.17
  • Accepted : 2023.10.24
  • Published : 2023.10.30
Download PDF
⟨ Previous Next ⟩

Abstract

This review article explores the psychological characteristics, comorbid mental disorders, and psychosocial assessments throughout the solid organ transplant journey, spanning the pre-transplant, peri-transplant, and post-transplant phases for transplant recipients. The psychological burden and anxiety in the pre-transplant phase are high for organ failure patients with complex physical difficulties who are deciding to undergo transplantation and are on the waiting list. The pre-transplant psychosocial evaluation covers various aspects, including the patient's readiness, awareness of, and commitment to transplant treatment, medical compliance, psychopathological conditions such as cognitive function and personality disorders, lifestyle factors, including substance abuse, as well as various psychosocial factors like social support. During the peri-transplant phase, mental health problems such as postoperative delirium should be carefully recognized and addressed. After transplantation, it is essential to assist patients in coping with the various stressful experiences they encounter, manage psychiatric symptoms such as depression, anxiety, and insomnia, and improve treatment adherence and quality of life during long-term care for the transplanted organ. Managing psychiatric problems in post-transplant patients requires a deep understanding of immunosuppressant medications and a keen awareness of associated risks, including adverse effects and potential drug interactions. This comprehensive review emphasizes the significance of proactive mental health care and psychosocial evaluation, highlighting the necessity of a multidisciplinary approach to enhance the quality of life and overall success of transplant patients throughout all phases of transplantation.

Keywords

Acknowledgement

본 연구는 과학기술정보통신부의 재원으로 한국연구재단의 지원(NRF-2019R1A2C1084611)에 의하여 이루어졌음.

References

  1. Black CK, Termanini KM, Aguirre O, Hawksworth JS, Sosin M. Solid organ transplantation in the 21(st) century. Ann Transl Med 2018;6:409.
  2. Sarkar S, Grover S, Chadda RK. Psychiatric assessment of persons for solid-organ transplant. Indian J Psychiatry 2022;64:S308-s318. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_1015_21
  3. Heinrich TW, Marcangelo M. Psychiatric issues in solid organ transplantation. Harv Rev Psychiatry 2009;17:398-406. https://doi.org/10.3109/10673220903463259
  4. Corbett C, Armstrong MJ, Parker R, Webb K, Neuberger JM. Mental health disorders and solid-organ transplant recipients. Transplantation 2013;96:593-600. https://doi.org/10.1097/TP.0b013e31829584e0
  5. Medved V, Medved S, Skocic Hanzek M. Transplantation psychiatry: an overview. Psychiatr Danub 2019;31:18-25. https://doi.org/10.24869/psyd.2019.18
  6. Dew MA, Rosenberger EM, Myaskovsky L, DiMartini AF, DeVito Dabbs AJ, Posluszny DM, et al. Depression and anxiety as risk factors for morbidity and mortality after organ transplantation: a systematic review and meta-analysis. Transplantation 2015;100:988-1003. https://doi.org/10.1097/TP.0000000000000901
  7. Corbett C, Armstrong MJ, Parker R, Webb K, Neuberger JM. Mental health disorders and solid-organ transplant recipients. Transplantation 2013;96:593-600. https://doi.org/10.1097/TP.0b013e31829584e0
  8. Kuntz K, Weinland SR, Butt Z. Psychosocial challenges in solid organ transplantation. J Clin Psychol Med Settings 2015;22:122-135. https://doi.org/10.1007/s10880-015-9435-6
  9. Schulz K, Kroencke S. Psychosocial challenges before and after organ transplantation. Transplant Research and Risk Management 2015;7:45-58. https://doi.org/10.2147/TRRM.S53107
  10. Li PK, Chu KH, Chow KM, Lau MF, Leung CB, Kwan BC, et al. Cross sectional survey on the concerns and anxiety of patients waiting for organ transplants. Nephrology (Carlton) 2012;17:514-518. https://doi.org/10.1111/j.1440-1797.2012.01615.x
  11. Corruble E, Durrbach A, Charpentier B, Lang P, Amidi S, Dezamis A, et al. Progressive increase of anxiety and depression in patients waiting for a kidney transplantation. Behav Med 2010;36:32-36. https://doi.org/10.1080/08964280903521339
  12. Vermeulen KM, Bosma OH, Bij W, Koeter GH, Tenvergert EM. Stress, psychological distress, and coping in patients on the waiting list for lung transplantation: an exploratory study. Transpl Int 2005;18:954-959. https://doi.org/10.1111/j.1432-2277.2005.00169.x
  13. Fukunishi I, Sugawara Y, Takayama T, Makuuchi M, Kawarasaki H, Surman OS. Psychiatric disorders before and after living-related transplantation. Psychosomatics 2001;42:337-343. https://doi.org/10.1176/appi.psy.42.4.337
  14. Delibasic M, Mohamedali B, Dobrilovic N, Raman J. Pre-transplant depression as a predictor of adherence and morbidities after orthotopic heart transplantation. J Cardiothorac Surg 2017;12:62.
  15. Guimaro MS, Lacerda SS, Karam CH, Ferraz-Neto BH, Andreoli PB. Psychosocial profile of patients on the liver transplant list. Transplant Proc 2008;40:782-784. https://doi.org/10.1016/j.transproceed.2008.02.040
  16. Rogal SS, Landsittel D, Surman O, Chung RT, Rutherford A. Pretransplant depression, antidepressant use, and outcomes of orthotopic liver transplantation. Liver Transpl 2011;17:251-260. https://doi.org/10.1002/lt.22231
  17. Dew MA, Roth LH, Schulberg HC, Simmons RG, Kormos RL, Trzepacz PT, et al. Prevalence and predictors of depression and anxiety-related disorders during the year after heart transplantation. Gen Hosp Psychiatry 1996;18:48S-61S. https://doi.org/10.1016/S0163-8343(96)00077-1
  18. Spaderna H, Smits JM, Rahmel AO, Weidner G. Psychosocial and behavioural factors in heart transplant candidates--an overview. Transpl Int 2007;20:909-920. https://doi.org/10.1111/j.1432-2277.2007.00503.x
  19. Parekh PI, Blumenthal JA, Babyak MA, Merrill K, Carney RM, Davis RD, et al. Psychiatric disorder and quality of life in patients awaiting lung transplantation. Chest 2003;124:1682-1688. https://doi.org/10.1378/chest.124.5.1682
  20. Akman B, Uyar M, Afsar B, Sezer S, Ozdemir FN, Haberal M. Adherence, depression and quality of life in patients on a renal transplantation waiting list. Transpl Int 2007;20:682-687. https://doi.org/10.1111/j.1432-2277.2007.00495.x
  21. Rodrigue JR, Nelson DR, Hanto DW, Reed AI, Curry MP. Patient-reported immunosuppression nonadherence 6 to 24 months after liver transplant: association with pretransplant psychosocial factors and perceptions of health status change. Prog Transplant 2013;23:319-328. https://doi.org/10.7182/pit2013501
  22. Sheehan JD. Liaison psychiatry: heart and lung transplantation. BJPsych Advances 2018;24:167 - 173. https://doi.org/10.1192/bja.2017.20
  23. Bailey P, Vergis N, Allison M, Riddell A, Massey E. Psychosocial Evaluation of Candidates for Solid Organ Transplantation. 2021;105:e292-e302. https://doi.org/10.1097/TP.0000000000003732
  24. Olbrisch ME, Levenson, J. L., Hamer, R. The PACT: A rating scale for the study of clinical decision-making in psychosocial screening of organ transplant candidates. Clinical Transplantation 1989;3:164-169. https://doi.org/10.1111/j.1399-0012.1989.tb00176.x
  25. Twillman RK, Manetto C, Wellisch DK, Wolcott DL. The Transplant Evaluation Rating Scale. A revision of the psychosocial levels system for evaluating organ transplant candidates. Psychosomatics 1993;34:144-153. https://doi.org/10.1016/S0033-3182(93)71905-2
  26. Maldonado JR, Dubois HC, David EE, Sher Y, Lolak S, Dyal J, et al. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT): a new tool for the psychosocial evaluation of pretransplant candidates. Psychosomatics 2012;53:123-132. https://doi.org/10.1016/j.psym.2011.12.012
  27. Maldonado JR, Sher Y, Lolak S, Swendsen H, Skibola D, Neri E, et al. The stanford integrated psychosocial assessment for transplantation: a prospective study of medical and psychosocial outcomes. Psychosom Med 2015;77:1018-1030. https://doi.org/10.1097/PSY.0000000000000241
  28. Lieber SR, Volk ML. Non-adherence and graft failure in adult liver transplant recipients. Dig Dis Sci 2013;58:824-834. https://doi.org/10.1007/s10620-012-2412-0
  29. Mackie J, Groves K, Hoyle A, Garcia C, Garcia R, Gunson B, et al. Orthotopic liver transplantation for alcoholic liver disease: a retrospective analysis of survival, recidivism, and risk factors predisposing to recidivism. Liver Transpl 2001;7:418-427. https://doi.org/10.1053/jlts.2001.23789
  30. Tome S, Lucey MR. Timing of liver transplantation in alcoholic cirrhosis. J Hepatol 2003;39:302-307. https://doi.org/10.1016/S0168-8278(03)00290-3
  31. Iruzubieta P, Crespo J, Fabrega E. Long-term survival after liver transplantation for alcoholic liver disease. World J Gastroenterol 2013;19:9198-9208. https://doi.org/10.3748/wjg.v19.i48.9198
  32. Berlakovich GA, Imhof M, Karner-Hanusch J, Gotzinger P, Gollackner B, Gnant M, et al. The importance of the effect of underlying disease on rejection outcomes following orthotopic liver transplantation. Transplantation 1996;61:554-560. https://doi.org/10.1097/00007890-199602270-00007
  33. Bellamy CO, DiMartini AM, Ruppert K, Jain A, Dodson F, Torbenson M, et al. Liver transplantation for alcoholic cirrhosis: long term follow-up and impact of disease recurrence. Transplantation 2001;72:619-626. https://doi.org/10.1097/00007890-200108270-00010
  34. Shapiro PA, Williams DL, Foray AT, Gelman IS, Wukich N, Sciacca R. Psychosocial evaluation and prediction of compliance problems and morbidity after heart transplantation. Transplantation 1995;60:1462-1466. https://doi.org/10.1097/00007890-199560120-00016
  35. Morana JG. Psychological evaluation and follow-up in liver transplantation. World Journal of Gastroenterology 2009;15:694-696. https://doi.org/10.3748/wjg.15.694
  36. Teperman LW. Impact of pretransplant hepatic encephalopathy on liver posttransplantation outcomes. Int J Hepatol 2013;2013:952828.
  37. Bouhlel S. Can patients with schizophrenia undergo renal transplantation with success? Saudi J Kidney Dis Transpl 2014;25:605-609. https://doi.org/10.4103/1319-2442.132203
  38. Zwaan M, Erim Y, Kroncke S, Vitinius F, Buchholz A, Nohre M. Psychosocial diagnosis and treatment before and after organ transplantation. Dtsch Arztebl Int 2023;120:413-416. https://doi.org/10.3238/arztebl.m2023.0087
  39. Chu NM, Segev DL, McAdams-DeMarco MA. Delirium among adults undergoing solid organ transplantation. Curr Transplant Rep 2021;8:118-126. https://doi.org/10.1007/s40472-021-00326-1
  40. Haugen CE, Mountford A, Warsame F, Berkowitz R, Bae S, Thomas AG, et al. Incidence, risk factors, and sequelae of post-kidney transplant delirium. J Am Soc Nephrol 2018;29:1752-1759. https://doi.org/10.1681/ASN.2018010064
  41. Sher Y, Zimbrean P. Psychiatric aspects of organ transplantation in critical care: an update. Crit Care Clin 2017;33:659-679. https://doi.org/10.1016/j.ccc.2017.03.009
  42. Smith PJ, Rivelli S, Waters A, Reynolds J, Hoyle A, Flowers M, et al. Neurocognitive changes after lung transplantation. Ann Am Thorac Soc 2014;11:1520-1527. https://doi.org/10.1513/AnnalsATS.201406-232OC
  43. DeBolt CL, Gao Y, Sutter N, Soong A, Leard L, Jeffrey G, et al. The association of post-operative delirium with patient-reported outcomes and mortality after lung transplantation. Clin Transplant 2021;35:e14275.
  44. Wang SH, Wang JY, Lin PY, Lin KH, Ko CJ, Hsieh CE, et al. Predisposing risk factors for delirium in living donor liver transplantation patients in intensive care units. PLoS One 2014;9:e96676.
  45. van Sandwijk MS, Ten Berge IJM, Caan MWA, During M, van Gool WA, Majoie C, et al. Cognitive improvement after kidney transplantation is associated with structural and functional changes on MRI. Transplant Direct 2020;6:e531.
  46. Binari LA, Kiehl AL, Jackson JC, Feurer ID, Rega SA, Altuhaifi TM, et al. Neurocognitive function changes following kidney transplant: a prospective study. Kidney Med 2022;4:100560.
  47. Smith PJ, Blumenthal JA, Hoffman BM, Davis RD, Palmer SM. Postoperative cognitive dysfunction and mortality following lung transplantation. Am J Transplant 2018;18:696-703. https://doi.org/10.1111/ajt.14570
  48. Aceto P, Perilli V, Lai C, Ciocchetti P, Vitale F, Sollazzi L. Postoperative cognitive dysfunction after liver transplantation. Gen Hosp Psychiatry 2015;37:109-115. https://doi.org/10.1016/j.genhosppsych.2014.12.001
  49. Riviere J, van der Mast RC, Vandenberghe J, Van Den Eede F. Efficacy and tolerability of atypical antipsychotics in the treatment of delirium: a systematic review of the literature. Psychosomatics 2019;60:18-26. https://doi.org/10.1016/j.psym.2018.05.011
  50. Kiino E. Use of aripiprazole for delirium in the elderly: a short review. Psychogeriatrics 2015;15:75-84. https://doi.org/10.1111/psyg.12088
  51. Telles-Correia D, Barbosa A, Cortez-Pinto H, Campos C, Rocha NB, Machado S. Psychotropic drugs and liver disease: a critical review of pharmacokinetics and liver toxicity. World J Gastrointest Pharmacol Ther 2017;8:26-38. https://doi.org/10.4292/wjgpt.v8.i1.26
  52. Biswas T, Mishra S, Mishra BR. Psychological graft-rejection: a need to understand the construct in transplant scenarios. Asian Journal of Psychiatry 2023;85:103625.
  53. Muslin HL. On acquiring a kidney. American Journal of Psychiatry 1971;127:1185-1188. https://doi.org/10.1176/ajp.127.9.1185
  54. Havik OE, Sivertsen B, Relbo A, Hellesvik M, Grov I, Geiran O, et al. Depressive symptoms and all-cause mortality after heart transplantation. Transplantation 2007;84:97-103. https://doi.org/10.1097/01.tp.0000268816.90672.a0
  55. Limbos MM, Joyce DP, Chan CK, Kesten S. Psychological functioning and quality of life in lung transplant candidates and recipients. Chest 2000;118:408-416. https://doi.org/10.1378/chest.118.2.408
  56. Rzeszut M, Assael R. Differentiating depression from demoralization in organ transplantation recipients. Prog Transplant 2021;31:88-90. https://doi.org/10.1177/1526924820978602
  57. Robinson S, Kissane DW, Brooker J, Burney S. A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research. Journal of Pain and Symptom Management 2015;49:595-610. https://doi.org/10.1016/j.jpainsymman.2014.07.008
  58. Loh AZH, Tan JSY, Tam JKC, Zhang MW, Ho CSH, Ho RC. Postoperative psychological disorders among heart transplant recipients: a meta-analysis and meta-regression. Psychosom Med 2020;82:689- 698. https://doi.org/10.1097/PSY.0000000000000833
  59. Biyyala D, Joseph R, Varadharajan N, Krishnamoorthy Y, Menon V. Incidence and prevalence of depressive, anxiety, and insomnia symptoms among adult liver transplant recipients: a systematic review and meta-analysis. Gen Hosp Psychiatry 2023;80:26-34. https://doi.org/10.1016/j.genhosppsych.2022.12.003
  60. Lim WH, Poh CW, Tan BJM, Ng CH, Tan DJH, Lim XC, et al. Global prevalence, risk factors, and outcomes of depression after liver transplant: a systematic review and meta-analysis. Gastro Hep Advances 2022;1:150-159. https://doi.org/10.1016/j.gastha.2021.12.001
  61. Dew MA, DiMartini AF, DeVito Dabbs AJ, Fox KR, Myaskovsky L, Posluszny DM, et al. Onset and risk factors for anxiety and depression during the first 2 years after lung transplantation. Gen Hosp Psychiatry 2012;34:127-138. https://doi.org/10.1016/j.genhosppsych.2011.11.009
  62. Rosenberger EM, Dew MA, Crone C, DiMartini AF. Psychiatric disorders as risk factors for adverse medical outcomes after solid organ transplantation. Curr Opin Organ Transplant 2012;17:188-192. https://doi.org/10.1097/MOT.0b013e3283510928
  63. Davydow DS, Lease ED, Reyes JD. Posttraumatic stress disorder in organ transplant recipients: a systematic review. General Hospital Psychiatry 2015;37:387-398. https://doi.org/10.1016/j.genhosppsych.2015.05.005
  64. Cordoza M, Koons B, Perlis ML, Anderson BJ, Diamond JM, Riegel B. Self-reported poor quality of sleep in solid organ transplant: a systematic review. Transplantation Reviews 2021;35:100650.
  65. Warrington TP, Bostwick JM. Psychiatric adverse effects of corticosteroids. Mayo Clin Proc 2006;81:1361-1367. https://doi.org/10.4065/81.10.1361
  66. Taylor D, Paton C, Kapur S, South London and Maudsley NHS Trust. The Maudsley prescribing guidelines in psychiatry. Chichester, West Sussex; Hoboken, NJ: John Wiley & Sons Inc.; 2015, p.1 online resource.
  67. Katalin M. Metabolic Drug Interactions with Immunosuppressants. In: Georgios T, editor. Organ Donation and Transplantation. Rijeka: IntechOpen;2018, p.Ch. 20.
  68. Jorga A, Holt DW, Johnston A. Therapeutic drug monitoring of cyclosporine. Transplant Proc 2004;36:396S-403S. https://doi.org/10.1016/j.transproceed.2004.01.013
  69. Kim J, Phongsamran P, Park S. Use of Antidepressant drugs in transplant recipients. Progress in Transplantation 2004;14:98-104. https://doi.org/10.1177/152692480401400204
  70. Hemeryck A, Belpaire FM. Selective serotonin reuptake inhibitors and cytochrome P-450 mediated drug-drug interactions: an update. Curr Drug Metab 2002;3:13-37. https://doi.org/10.2174/1389200023338017
  71. Crone CC, Gabriel GM. Treatment of anxiety and depression in transplant patients: pharmacokinetic considerations. Clin Pharmacokinet 2004;43:361-394. https://doi.org/10.2165/00003088-200443060-00002
  72. Mullish BH, Kabir MS, Thursz MR, Dhar A. Review article: depression and the use of antidepressants in patients with chronic liver disease or liver transplantation. Alimentary Pharmacology & Therapeutics 2014;40:880-892. https://doi.org/10.1111/apt.12925
  73. Spina E, Santoro V, D'Arrigo C. Clinically relevant pharmacokinetic drug interactions with second-generation antidepressants: an update. Clinical Therapeutics 2008;30:1206-1227. https://doi.org/10.1016/S0149-2918(08)80047-1
  74. Sheehan J. Liaison psychiatry: Heart and lung transplantation. BJPsych Advances 2018;24:167-173. https://doi.org/10.1192/bja.2017.20
  75. Gross CR, Kreitzer MJ, Thomas W, Reilly-Spong M, Cramer-Bornemann M, Nyman JA, et al. Mindfulness-based stress reduction for solid organ transplant recipients: a randomized controlled trial. Altern Ther Health Med 2010;16:30-38.
  76. Febrero B, Ramirez P, Martinez-Alarcon L, Abete C, Galera M, Rios A, et al. Group psychotherapy could improve depression in cirrhotic patients on the liver transplant waiting list. Transplant Proc 2019;51:28-32. https://doi.org/10.1016/j.transproceed.2018.02.206