Psychoactive Medication Use in Pediatric Heart Transplant Recipients: An Assessment of Prevalence, Risk Factors, and Outcomes

BACKGROUND: There is increasing recognition of the mental health toll of heart transplant on pediatric transplant patients and their families. Little is known about the use of psychoactive medications in this population. METHODS: The Pediatric Heart Transplant Society (PHTS) collects data on patients pre and post-transplant including medication use for anxiety, depression, and attention deficit/hyperactivity disorder. We analyzed psychoactive medication use among transplant recipients older than 5 years at follow-up and assessed for associations with pre-transplant risk factors and post-transplant outcomes. A survey about mental health resources was sent to all PHTS sites. RESULTS: Among 1792 patients older than 5 years at 1 year post transplant, 301 patients (16.8%) were prescribed at least one psychoactive medication, 246 (13.7%) were prescribed antianxiety/antidepressant medications, and 59 (3.3%) were prescribed medications for ADHD. Patients on psychoactive medications at 1 year post transplant tended to be older and more sick at the time of transplant. There was no association between psychoactive medication use on graft loss, coronary artery disease, or rejection at 1-year post-transplant; there was a higher incidence of coronary artery disease at 3 years post transplant and increased coronary artery disease and graft loss at 5 years post transplant. Screening instrument usage varied across sites. Mental health providers are typically available for patients but vary with regard to timing and disciplines involved across centers. CONCLUSIONS: A significant proportion of pediatric heart transplant recipients take psychoactive medications. Psychoactive medication usage is associated with worse long-term outcomes including graft loss and coronary artery disease.