Journal Article Annotations
2021, 4th Quarter

Transplant Psychiatry

Annotations by Sarah R. Andrews, MD
December, 2021

Coping strategies, anxiety and depression related to the COVID-19 pandemic in lung transplant candidates and recipients. Results from a monocenter series.
Factors Having an Impact on Relapse and Survival in Transplant Recipients With Alcohol-Induced Liver Disease.

PUBLICATION #1 — Transplant Psychiatry

Coping strategies, anxiety and depression related to the COVID-19 pandemic in lung transplant candidates and recipients. Results from a monocenter series.

Alice Savary, Malika Hammouda, Lucie Genet, Cendrine Godet, Vincent Bunel, Gaelle Weisenburger, Tiphaine Goletto, Chahine Medraoui, Gilles Jebrak, Armelle Marceau, Alexy Tran-Dinh, Pierre Mordant, Yves Castier, Philippe Montravers, Herve Mal, Jonathan Messika, Bichat Lung Transplant Group

Abstract: Respir Med Res. 2021 Nov;80:100847. doi: 10.1016/j.resmer.2021.100847. Epub 2021 Jul 7.

Background:
The COVID-19 pandemic has been associated with an increase in anxiety and depression symptoms in people. We investigated the impact of the pandemic on coping strategies and anxiety and depression in lung transplantation (LT) recipients and patients with end-stage chronic lung disease awaiting LT.

Methods:
We retrospectively investigated coping strategies by using the Coping Inventory for Stressful Situations questionnaire and anxiety and depression symptoms by the Hospital Anxiety and Depression scale in 115 LT candidates and recipients.

Results:
Overall, 63 participants (20 women; median age 59 years [interquartile range 52•65]) answered one or both questionnaires (49 LT recipients and 14 LT candidates). The preferred coping strategy was task-focused for 51 (86.4%) participants, with no difference between LT recipients and candidates nor according to the main anamnestic and clinical data. Eleven patients had suspected or proven depression symptoms, and 18 had suspected or proven anxiety symptoms. Coping strategies related to COVID-19 did not differ by presence of anxiety or depression symptoms.

Conclusion:
In the current pandemic, healthcare professionals should consider these results to provide relevant psychological help to these fragile populations and promote a systematic and wide multidisciplinary assessment of LT recipients and candidates.

Keywords:
Anxiety; COVID-19; Coping strategy; Depression; Lung transplantation.

Annotation

The finding:
This single-study retrospective study evaluated 49 lung transplant recipients and 14 lung transplant candidates for anxiety and depression symptoms through the Hospital Anxiety and Depression Scale. Coping strategies were also assessed by using the Coping Inventory for Stressful Situations questionnaire. From these 63 participants, 11 (17%) and 18 (29%) patients exhibited depressive and anxiety symptoms, respectively. Anxiety was more common in patients who experienced lockdown outside versus inside their usual home. Task-focused strategies were the preferred coping strategy for patients. No significant differences were found between lung transplant recipients and candidates.

Strength and weaknesses:
The strength of this study is involving both coping strategies as well as evaluating anxiety and depression. It also has limitations, including the small sample size from one location given that patients from different countries or populations may have differing responses to the COVID-19 pandemic.

Relevance:
Anxiety and depression are common in the lung transplant population, both in recipients and candidates, and the COVID-19 pandemic has worsened the risk of psychiatric symptoms in this fragile population. The study is relevant to the Cl-L psychiatrist in helping to identify anxiety or depression-provoking situations within this population.

PUBLICATION #2 — Transplant Psychiatry

Factors Having an Impact on Relapse and Survival in Transplant Recipients With Alcohol-Induced Liver Disease.

Terry D Schneekloth, Juan P Arab, Douglas A Simonetto, Tanya M Petterson, Shehzad K Niazi, Daniel K Hall-Flavin, Victor M Karpyak, Bhanu P Kolla, James E Roth, Walter K Kremers, Charles B Rosen

Abstract: Mayo Clin Proc Innov Qual Outcomes. 2021 Dec 8;5(6):1153-1164. doi: 10.1016/j.mayocpiqo.2021.10.005. eCollection 2021 Dec.

Objective:
To assess the impact of standardized pretransplant alcohol abstinence and treatment guidelines on liver transplant outcomes.

Methods:
This study assessed the posttransplant relapse and survival associated with a pretransplant guideline mandating alcohol abstinence, addiction treatment, and Alcoholics Anonymous (AA) attendance. This retrospective cohort study included liver recipients with alcohol-induced liver disease transplanted between January 1, 2000, and December 31, 2012, at a Midwest transplant center. Cox regression models tested for associations between pretransplant treatment, demographic and clinical characteristics, and outcome measures.

Results:
Of 236 liver recipients (188 [79.7%] male; 210 [89%] white; mean follow-up, 88.6±55.0 months), 212 (90.2%) completed pretransplant treatment and 135 (57.2%) attended AA weekly. At 5 years, 16.3% and 8.2% had relapsed to any alcohol use and to high-dose drinking, respectively. Smoking during the 6 months before transplant was associated with any relapse (P=.0002) and high-dose relapse (P<.0001), and smoking at transplant was associated with death (P=.001). High-dose relapse was associated with death (hazard ratio, 3.5; P<.0001).

Conclusion:
A transplant center with a guideline requiring abstinence, treatment, and AA participation experienced lower posttransplant relapse rates from those previously reported in comparable large US transplant programs. Smoking cessation may further improve posttransplant outcomes.

Keywords:
AA, Alcoholics Anonymous; ALD, alcoholic liver disease; NIAAA, National Institute on Alcohol Abuse and Alcoholism.

Annotation

The finding
This retrospective cohort study included 236 liver transplant recipients with alcohol-induced liver disease from one transplant center from 2000 until 2012. From these liver recipients, over 90 percent had completed pre-transplant treatment and over half attended Alcoholics Anonymous (AA). After five years post-transplant, 16.3% who had completed pre-transplant treatment relapsed, while 8.2% of those who engaged in weekly AA meetings had relapsed. Smoking prior to transplant was associated with relapse, and smoking at transplant was associated with death.

Strengths and weaknesses
This study had several strengths, including the ongoing close follow-up of transplant recipients regarding alcohol consumption. One weaknesswas the unclear objective assessment of evaluating patients’ alcohol consumption post-transplant given that return to alcohol consumption when self-reported can be underreported. Furthermore, AA meetings and treatment pre-transplant can vary significantly in quality.

Relevance
This study is relevant to transplant psychiatrists evaluating and managing liver transplant recipients with alcohol-induced liver disease. The association between smoking prior to and following transplant with morbidity and mortality will be helpful as we guide patients through the transplant process and help them reduce their alcohol and tobacco consumption.