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Early treatment for depression after liver transplantation linked to better survival

Adequate pharmacotherapy for depression within 1 year of liver transplantation was associated with improved survival rates in a recent study.

Researchers evaluated 167 patients who underwent liver transplantation (LT) because of alcohol-related liver disease between 1998 and 2003. Symptoms of depression were assessed via the Beck Depression Inventory (BDI) every 3 months for the first year post-transplantation, and the adequacy of treatment with antidepressants among recipients was measured by the five-point Antidepressant Treatment History Form.

Depression was reported by 72 participants, including 31 who received adequate therapy with antidepressants, seven who received inadequate therapy and 34 who were untreated. Patients with high BDI scores at baseline were more likely to receive adequate pharmacotherapy than patients with rising scores (65% of cases vs. 27%; P=.003).

Survival rates during a median follow-up of 9.5 years were 56% among nondepressed patients, 52% in the adequately treated group and 32% of inadequately treated/untreated patients (P=.006 for difference). No significant difference in survival was observed between patients without depression and depressed patients who received adequate pharmacotherapy, while patients who received inadequate pharmacotherapy were at increased mortality risk compared with nondepressed patients after adjusting for confounders (HR=2.44; 95% CI, 1.45-4.11).

Investigators said untreated depression was the evaluated factor most strongly associated with long-term mortality risk after transplantation. Other independently associated factors included advanced age (HR=1.04; 95% CI, 1.01-1.07) and a greater number of comorbidities as indicated by the Charlson comorbidity index (HR=1.29; 95% CI, 1.13-1.48), while no associations were observed between survival and MELD score, alcohol consumption, HCV status and donor age.

“This is the first demonstration that treating depression early in the post-LT course is associated with improved long-term mortality,” the researchers concluded. “Remarkably, depression treatment status proved to be more strongly associated with survival than MELD, donor age or HCV status, traditional risk factors for mortality in this population. This suggests that depression is a modifiable nonsurgical, nonhepatologic risk factor for poor LT outcomes and that may be improved by early identification and treatment.”