TY - JOUR
T1 - Posttransplantation outcomes in veterans with serious mental illness
AU - Evans, Lianna D.
AU - Stock, Eileen M.
AU - Zeber, John E.
AU - Morissette, Sandra B.
AU - MacCarthy, Andrea A.
AU - Sako, Edward Y.
AU - Lappin, Jacqueline
AU - Lawrence, Valerie A.
AU - MacCarthy, Daniel J.
AU - Copeland, Laurel A.
N1 - Publisher Copyright:
Copyright © 2015 Wolters Kluwer Health, Inc.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Background. Anticipating poor recovery due to impaired self-management and appointment-keeping, clinicians may consider serious mental illness (SMI) a significant concern in organ transplantation. However, little empirical evidence exists regarding posttransplantation outcomes for patients with SMI. Methods. This study analyzed health services data to evaluate post transplantation 3-year survival bySMI status in a nationwide cohort of patients in the Veterans Health Administration (VHA). Results.A total of 960 recipients of solid organ or bonemarrowtransplants were identified from Veterans Health Administration administrative data extracts for fiscal years 2006 to 2009. Of these, 164 (17%) had an SMI diagnosis before transplantation (schizophrenia, posttraumatic stress, major depressive, and bipolar disorders); 301 (31%) had some othermental illness diagnosis (such as anxiety, adjustment reactions, or substance abuse); and 495 (52%) had no mental health diagnosis. Twenty-two patients (2%) required retransplantation and 208 patients (22%) died during follow-up. Data on whether these were primary or repeat transplantations were unavailable. Rates of attendance at postoperative outpatient visits and number of months for which immunosuppressive drugs fills were recorded were similar among mental illness groups, as were rates of diagnosed immunological rejection. Threeyear mortality was equivalent among mental health groups: no mental health (19%) versus other mental illness (23%) versus SMI (27%; X2 = 5.11; df= 2; P = .08). In adjusted survivalmodels, no effect ofmental health status was observed. Conclusions. Serious mental illness diagnosis does not appear to be associated with adverse transplantation outcomes over the first 3 years; however, a potentially diverging survival curve may portend higher mortality at 5 years.
AB - Background. Anticipating poor recovery due to impaired self-management and appointment-keeping, clinicians may consider serious mental illness (SMI) a significant concern in organ transplantation. However, little empirical evidence exists regarding posttransplantation outcomes for patients with SMI. Methods. This study analyzed health services data to evaluate post transplantation 3-year survival bySMI status in a nationwide cohort of patients in the Veterans Health Administration (VHA). Results.A total of 960 recipients of solid organ or bonemarrowtransplants were identified from Veterans Health Administration administrative data extracts for fiscal years 2006 to 2009. Of these, 164 (17%) had an SMI diagnosis before transplantation (schizophrenia, posttraumatic stress, major depressive, and bipolar disorders); 301 (31%) had some othermental illness diagnosis (such as anxiety, adjustment reactions, or substance abuse); and 495 (52%) had no mental health diagnosis. Twenty-two patients (2%) required retransplantation and 208 patients (22%) died during follow-up. Data on whether these were primary or repeat transplantations were unavailable. Rates of attendance at postoperative outpatient visits and number of months for which immunosuppressive drugs fills were recorded were similar among mental illness groups, as were rates of diagnosed immunological rejection. Threeyear mortality was equivalent among mental health groups: no mental health (19%) versus other mental illness (23%) versus SMI (27%; X2 = 5.11; df= 2; P = .08). In adjusted survivalmodels, no effect ofmental health status was observed. Conclusions. Serious mental illness diagnosis does not appear to be associated with adverse transplantation outcomes over the first 3 years; however, a potentially diverging survival curve may portend higher mortality at 5 years.
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U2 - 10.1097/TP.0000000000000616
DO - 10.1097/TP.0000000000000616
M3 - Article
C2 - 25706275
AN - SCOPUS:84942465707
SN - 0041-1337
VL - 99
SP - e57-e65
JO - Transplantation
JF - Transplantation
IS - 8
ER -