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PLoS One. 2016 Nov 7;11(11):e0165517. doi: 10.1371/journal.pone.0165517. eCollection 2016.

Pre-Transplant Depression Is Associated with Length of Hospitalization, Discharge Disposition, and Survival after Liver Transplantation.

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Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America.
Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America.
Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States of America.
Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America.
Rand Corporation, Pittsburgh, PA, United States of America.
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States of America.


Depression after liver transplantation has been associated with decreased survival, but the effects of pre-transplant depression on early and late post-transplant outcomes remain incompletely evaluated. We assessed all patients who had undergone single-organ liver transplantation at a single center over the prior 10 years. A diagnosis of pre-transplant depression, covariates, and the outcomes of interest were extracted from the electronic medical record. Potential covariates included demographics, etiology and severity of liver disease, comorbidities, donor age, graft type, immunosuppression, and ischemic times. In multivariable models adjusting for these factors, we evaluated the effect of pre-transplant depression on transplant length of stay (LOS), discharge disposition (home vs. facility) and long-term survival. Among 1115 transplant recipients with a median follow-up time of 5 years, the average age was 56±11 and MELD was 12±9. Nineteen percent of the study population had a history of pre-transplant depression. Pre-transplant depression was associated with longer LOS (median = 19 vs. 14 days, IRR = 1.25, CI = 1.13,1.39), discharge to a facility (36% vs. 25%, OR 1.70,CI = 1.18,2.45), and decreased survival (HR = 1.54,CI = 1.14,2.08) in this cohort, accounting for other potential confounders. In conclusion, pre-transplant depression was significantly associated with longer transplant length of stay, discharge to a facility, and mortality in this cohort.

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Conflict of interest statement

We have the following interests: MC is employed by Rand Corporation. SR and NJ receive grant funding to the institution from Gilead Sciences unrelated to the presented work. NJ has also received compensation for serving on the advisory board of Gilead Sciences. SZ receives salary support from Gilead Sciences that is unrelated to this study. AH has received an honorarium for an unrelated talk from Shire Pharmaceutical. OS receives grant support from Gilead Sciences, Merit Medical Systems, Shinongi Pharmaceuticals, and Mallinckrodt Pharmaceuticals which is unrelated to the present study. There are no patents, products in development or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials.

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