It is no surprise that children and adolescents facing heart transplantation are prone to depression and anxiety. Yet, resources to address these comorbidities are often scarce.
Justin Godown, M.D., a pediatric cardiologist at Monroe Carell Jr. Children’s Hospital at Vanderbilt, recently found that not only are incidences of depression, anxiety and adjustment disorders high among transplant recipients, but these disorders are associated with readmission, rejection and inferior graft survival.
Godown examined how psychiatric diagnoses impacted outcomes following heart transplantation in patients ages 8 to 18 from over 50 children’s hospitals over the period from 2002 to 2016. The study was planned for presentation at the canceled 2020 Pediatric Academic Societies conference.
First author Kia Quinlan, a Vanderbilt medical student, cross-checked records from the Pediatric Health Information System and the Scientific Registry of Transplant Recipients, searching ICD codes for psychiatric diagnoses of depression, anxiety and adjustment disorders at or preceding transplantation.
Of the 1,192 patients included, 428 (35.9 percent) had psychiatric diagnoses, with adjustment disorders in 218 (18.3 percent), anxiety in 197 (16.5 percent) and depression in 133 (11.2 percent). This is starkly higher than the last CDC report of a 5 percent overall prevalence of depression or anxiety among children 6 to 17.
Ventricular assist device (VAD) use was associated with an even higher incidence of all three psychiatric diagnoses. A prior study led by Godown found nearly 40 percent of VAD patients had a psychiatric diagnosis.
Depression or anxiety during or preceding the transplant admission was independently associated with higher rates of readmission. Depression also was associated with inferior graft survival. “Depression has previously been associated with medication non-compliance, with clear implications for patients following solid organ transplantation,” Godown said.
“While transplant centers may offer psychiatric referrals, I’d like to see this expertise routinely available.”
Improving Dedicated Resources
Godown’s work highlights the value in conducting research in the youth heart transplant population, an area only starting to be explored. In the meantime, studies on adult transplant patients hint at antidepressant efficacy for youth.
For adult patients undergoing liver transplant, selective serotonin reuptake inhibitors (SSRIs) and selective non-adrenaline reuptake inhibitors (SNRIs) exhibit good safety profiles and positive outcomes. SSRI use for adult heart transplant patients with depression is as high as 92 percent and considered an important component for assuring medication adherence peri-transplant and beyond.
Whether medications or other measures prove to be the most effective therapy, Godown hopes more young patients will have access to psychiatric resources to make those determinations.
“While transplant centers may offer psychiatric referrals, I’d like to see this expertise routinely available to all these patients from early on in the process and throughout the post-transplant period,” Godown said.