PT  - JOURNAL ARTICLE
AU  - Nicholas A Kolaitis
AU  - Ying Gao
AU  - Allison Soong
AU  - John R Greenland
AU  - Steven R Hays
AU  - Jeffrey A Golden
AU  - Aida Venado
AU  - Lorriana E Leard
AU  - Rupal J Shah
AU  - Mary Ellen Kleinhenz
AU  - Patricia P Katz
AU  - Jasleen Kukreja
AU  - Paul D Blanc
AU  - Patrick J Smith
AU  - Jonathan Paul Singer
TI  - Depressive symptoms in lung transplant recipients: trajectory and association with mortality and allograft dysfunction
AID  - 10.1136/thoraxjnl-2021-217612
DP  - 2022 Mar 30
TA  - Thorax
PG  - thoraxjnl-2021-217612
4099  - http://thorax.bmj.com/content/early/2022/04/05/thoraxjnl-2021-217612.short
4100  - http://thorax.bmj.com/content/early/2022/04/05/thoraxjnl-2021-217612.full
AB  - 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.Data are available upon reasonable request.