Preexisting mental health disorders in lung transplant recipients were associated with higher 1-year mortality compared to those without (10.6% vs 8.5%; HR 1.24; 95% CI 1.09-1.41; p<0.001).
Cohort (n=10,164)
Yes
Do preexisting mental health disorders predict adverse 1-year outcomes in adult lung transplant recipients?
Preexisting mental health disorders in lung transplant recipients are associated with significantly worse 1-year outcomes, including higher mortality, acute rejection, infections, and healthcare utilization.
Effect estimate: HR 1.24 (95% CI 1.09-1.41)
Absolute Event Rate: 10.6% vs 8.5%
p-value: p=<0.001
Abstract Introduction Mental health disorders (MHD) are common among patients with chronic lung disease and may influence post-transplant recovery. However, their impact on lung transplant outcomes remains poorly characterized. This study evaluates 1-year post-transplant outcomes among adult lung transplant recipients with preexisting MHD. Methods A retrospective, multi-center analysis was conducted using the TriNetX US Collaborative Network (70 HCOs). Adults (≥18 years) who underwent lung transplantation between January 1, 2014, and January 1, 2024, were included. Cohort A had documented MHD (e.g., depression, anxiety, PTSD, psychotic disorders) within 2 years prior to transplant; Cohort B had no such diagnosis. Propensity score matching (1:1) balanced baseline characteristics (n = 5,082 per group). Outcomes assessed over 1 year included mortality, acute rejection ,pneumonia, CMV infection, mycosis, ICU admission, ER visits, and psychiatric complications. Hazard ratios and risk estimates were computed using Kaplan-Meier analysis. Results After propensity score matching (n = 5,082 per group), lung transplant recipients with preexisting mental health disorders (MHD) had significantly worse 1-year outcomes compared to those without. One-year mortality was higher in the MHD group (10.6% vs 8.5%; hazard ratio HR, 1.24; 95% CI 1.09-1.41; p 0.001). Rates of acute rejection were markedly elevated (29.1% vs 15.7%; HR, 2.02; 95% CI, 1.85-2.20;p 0.001), as were infections including pneumonia (18.7% vs 9.2%; HR, 2.15; 95% CI, 1.93-2.41; p 0.001), CMV infection (10.1% vs 5.6%; HR, 1.81; 95% CI, 1.57-2.09; p 0.001), and mycosis (6.6% vs 3.8%; HR, 1.78; 95% CI, 1.49-2.12; p 0.001). Healthcare utilization was higher in the MHD cohort, with more ICU admissions (20.3% vs 13.7%; HR, 1.54; 95% CI, 1.40-1.70; p 0.001) and emergency department visits (24.3% vs 18.6%; HR, 1.36; 95% CI, 1.25-1.48; p 0.001). Additionally, psychiatric complications were substantially more common. The incidence of acute psychosis was threefold higher (3.0% vs 0.9%; HR, 3.21; 95% CI, 2.31-4.45; p 0.001), and post-transplant major depressive episodes were notably elevated (40.2% vs 3.6%; HR, 14.35; 95% CI, 12.33-16.70; p 0.001). These findings demonstrate a consistent pattern of worse post-transplant morbidity and mortality among patients with preexisting mental health conditions. Discussion Lung transplant recipients with pre-transplant MHD experienced worse short-term clinical outcomes and higher psychiatric morbidity. Although propensity matching minimized baseline confounders, residual bias may persist. The retrospective design and coding variability in EHR data are additional limitations. Clinical Implications These findings underscore the importance of pre-transplant psychiatric screening, integrated behavioral care, and post-transplant mental health support. Proactive management of MHD may improve transplant outcomes and reduce healthcare utilization. This abstract is funded by: None
Gupta et al. (Fri,) conducted a cohort in Lung transplantation (n=10,164). Preexisting mental health disorders vs. No preexisting mental health disorders was evaluated on 1-year mortality (HR 1.24, 95% CI 1.09-1.41, p=<0.001). Preexisting mental health disorders in lung transplant recipients were associated with higher 1-year mortality compared to those without (10.6% vs 8.5%; HR 1.24; 95% CI 1.09-1.41; p<0.001).