One of the common psychological effects of chronic disease is major depressive disorder (MDD). Patients must cope with the possibility of organ rejection along with new physical changes involved in being a transplant recipient, including dealing with infection and being compliant with a complex series of immunosuppressive medications. However, the correlation between MDD and patient outcome following transplantation is not fully known.

A study by Fabienne Dobbels, PhD, director, Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium, and colleagues, sought to evaluate a possible link between MDD and adverse outcomes, including death, following kidney transplant. The study evaluated patient outcomes from 47,899 transplant patients who received a kidney transplant between 1995 and 2003.

The incidence of newly diagnosed MDD was 5.8 per 100 patient-years within the first year after transplantation. In the second year, the incidence was 2.6, and 2.2 in the third year, resulting in a 9.7% cumulative risk over 3 years.

In addition, the researchers found that there were serious adverse outcomes as result of an MDD diagnosis. Transplant in recipients with MDD were 2.11 times as likely to have graft failure or even death as those patients who did not have a diagnosis of MDD.

Also, MDD resulted in twice the risk of returning to dialysis or undergoing retransplantation. Finally, those diagnosed with MDD were 2.23 times at risk for death, even with a functional transplanted organ, than those patients who did not have an MDD diagnosis. All of these findings were statistically significant, with P <.0001.

"Depression doubles the risk if you control for many other characteristics," explained Dr. Dobbels in his presentation on May 8^th.

Based on these results, the researchers concluded that the presence of MDD is a serious risk factor for adverse outcomes in renal transplant patients in the first three years posttransplant. Patients diagnosed with MDD should be treated appropriately to help prevent these serious adverse events.

"Transplant surgeons should send their patients for regular psychological screening," said Dr. Dobbels.


[Presentation title: Depressive Disorder after Renal Transplantation: A Lethal Diagnosis? Abstract 1513]

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