Journal Article Annotations
2017, 2nd Quarter
Annotations by Paula Zimbrean, MD, FAPM
Also of interest:
This article describes the plan to establish a living kidney and liver donor registry for long-term follow-up of the organ donors. Ten transplant centers agreed to participate and the implementation of this registry is expected to take four years. The registry will include medical data from the evaluation for organ donation, and information obtained via surveys administered selectively every year after donation. The registry will also link to other national databases in order to assess prevalence of specific post-donation complications, such as end stage kidney disease. The registry also aims to allow development of other investigator-initiated trials, which may be of interest to psychiatrists involved in mental health evaluations for organ donation.
The finding: 39.4% of heart transplant recipients had some form of cognitive impairment, while one-third had cerebrovascular pathology noted on brain imaging. There were no significant differences in cognitive impairment between the two medication groups (everolimus versus calcineurin inhibitor-based regimen).
Strength and weaknesses: This study is remarkable by the extent of the cognitive assessment (17 measures) and by the fact that brain imaging was also performed, allowing discussion of the cause of the cognitive impairment. The limitations of this study reside in its cross-sectional design and in the fact that the study was done at one single centre in Norway with a relatively homogenous population, which questions the generalizability of its findings.
Relevance: This study reinforces the high prevalence of cognitive impairment in heart transplant recipients. It suggests that cognitive screening should be considered routinely in these patients. In addition, the study underlines the need for further prospective studies and studies exploring the causality of the cognitive impairment in these patients, likely through multicentre trials.
The finding: Almost half (44%) of lung transplant patients develop delirium at some point during their post-procedure hospitalization. Delirium in this population is associated with longer length of stay and longer stay in the intensive care unit, but not with mortality at 1 year posttransplantation. Risk factors for developing delirium post lung transplant include obesity and use of benzodiazepines.
Strength and weaknesses: This study assessed systematically the presence of delirium in a large cohort of lung transplant recipients. Particularly relevant for the clinician is the separate analysis of the early versus ever onset delirium in relation to the transplant surgery. The main limitation of this study comes, of course, from its retrospective chart review design.
Relevance: This study underscores the high incidence of delirium in lung transplant recipients and supports the finding, known to consultation-liaison psychiatrists but often challenged by other medical providers, that benzodiazepines increase the risk of delirium. These findings support the need for prospective studies of this topic and suggest that delirium prevention measures should be considered prior to lung transplantation or in the immediate postoperative period.