Neurobehavioral functioning and survival following lung transplantation

Abstract

Background: Neurobehavioral functioning is widely recognized as being an important consideration in lung transplant candidates, but little is known about whether these factors are related to clinical outcomes. The present study examined the relationship of neurobehavioral functioning, including measures of executive function and memory, depression, and anxiety, to long-term survival among lung transplant recipients.

Methods: The sample was drawn from 201 patients who underwent transplantation at Duke University and Washington University who participated in a dual-site clinical trial investigating medical and psychosocial outcomes in transplant candidates with end-stage lung disease. All patients completed the Beck Depression Inventory-II (BDI-II) and Spielberger State-Trait Anxiety Inventory at baseline and again after 12 weeks, while a subset of 86 patients from Duke University also completed neurocognitive testing. Patients were followed for survival up to 12 years after completing baseline assessments.

Results: One hundred eleven patients died over a mean follow-up of 10.8 years (SD=0.8). Baseline depression, anxiety, and neurocognitive function were examined as predictors of posttransplant survival, controlling for age, 6-min walk distance, FEV, and native disease; education and cardiovascular risk factors were also included in the model for neurocognition. Lower executive function (hazard ratio [HR]=1.09, P=.012) and memory performance (HR=1.11, P=.030) were independently associated with greater mortality following lung transplant. Although pretransplant depression and anxiety were not predictive of mortality, patients who scored>13 on the BDI-II at baseline and after 3 months pretransplant had greater mortality (HR=1.85 [95% CI, 1.04, 3.28], P=.036).

Conclusions: Neurobehavioral functioning, including persistently elevated depressive symptoms and lower neurocognitive performance, was associated with reduced survival after lung transplantation.

Trial registry: ClinicalTrials.gov; No.: NCT00113139; URL: www.clinicaltrials.gov.

Figures

Figure 1.

Flowchart of participants. Of the 201 INSPIRE participants who received transplants, 132 had both preintervention and postintervention depression assessments. Participants without posttreatment data were on the waitlist for a shorter amount of time compared with participants in the control condition (1.27 [SD = 2.07] y vs 2.25 [SD = 1.78] y, P < .001). In addition, because Washington University School of Medicine did not perform neurocognitive assessments, only 86 participants from Duke University Medical Center completed neurocognitive assessments. These patients tended to be less anxious compared with those persons who did not complete the testing. INSPIRE = Investigational Study of Psychological Intervention in Recipients of Lung Transplant.

Figure 2.

Kaplan-Meier survival curves of persistent depression and posttransplant survival. Participants with persistent depressive symptoms were more likely to die during the study follow-up compared with participants without persistent depressive symptoms (hazard ratio = 1.85, P = .036).