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Depressive symptoms in lung transplant recipients: trajectory and association with mortality and allograft dysfunction
  1. Nicholas A Kolaitis1,
  2. Ying Gao1,
  3. Allison Soong1,
  4. John R Greenland1,2,
  5. Steven R Hays1,
  6. Jeffrey A Golden1,
  7. Aida Venado1,
  8. Lorriana E Leard1,
  9. Rupal J Shah1,
  10. Mary Ellen Kleinhenz1,
  11. Patricia P Katz1,
  12. Jasleen Kukreja1,
  13. Paul D Blanc1,
  14. Patrick J Smith3,
  15. Jonathan Paul Singer1
  1. 1 Department of Medicine, University of California San Francisco, San Francisco, California, USA
  2. 2 Medicine, San Francisco VA Medical Center, San Francisco, California, USA
  3. 3 Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
  1. Correspondence to Dr Nicholas A Kolaitis, Department of Medicine, University of California San Francisco, San Francisco, California, USA; Nicholas.kolaitis{at}


Objective Most studies observing an association between depressive symptoms following lung transplantation and mortality are limited to depressive symptom measurement at a single time point, unrelated to allograft function. We aimed to test the association of depressive symptoms over multiple assessments with allograft dysfunction and with mortality.

Methods We assessed depressive symptoms before and serially up to 3 years after lung transplantation in lung transplant recipients. We quantified depressive symptoms with the Geriatric Depression Scale (GDS; range 0–15; minimally important difference (MID): 2). We quantified changes in GDS using linear mixed effects models and tested the association with mortality using Cox proportional hazards models with GDS as a time-dependent predictor. To determine if worsening in GDS preceded declines in lung function, we tested the association of GDS as a time-dependent predictor with the lagged outcome of FEV1 at the following study visit.

Results Among 266 participants, depressive symptoms improved early after transplantation. Worsening in post-transplant GDS by the MID was associated with mortality (HR 1.25, 95% CI 1.05 to 1.50), and in lagged outcome analyses with decreased per cent predicted FEV1 (Δ, −1.62%, 95% CI −2.49 to –0.76). Visual analyses of temporal changes in GDS demonstrated that worsening depressive symptoms could precede chronic lung allograft dysfunction.

Conclusions Depressive symptoms generally improve after lung transplantation. When they worsen, however, there is an association with declines in lung function and mortality. Depression is one of the few, potentially modifiable, risk factors for chronic lung allograft dysfunction and death.

  • lung transplantation
  • Psychology

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors NAK, PJS and JPS made substantial contribution to the conception and design of the work. NAK, YG, AS, JRG, SRH, JAG, AV, LEL, RJS, MEK, PPK, JK, PDB and JPS made substantial contribution to the acquisition, analysis or interpretation of data for the work. NAK wrote the first draft of the manuscript. YG, AS, JRG, SRH, JAG, AV, LEL, RJS, MEK, PPK, JK, PDB, PJS and JPS revised the manuscript for important intellectual content. NAK is the guarantor and accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding This study was funded by NHLBI K23 HL111115 (JPS), RO1 HL134851 (JPS) and VA CDA IK2CX002011 (JRG).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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