Friday, April 5, 2013

Depression Treatment Linked to Longer Transplant Survival

An elusive goal, the ability to favorably impact LONG TERM survival following liver transplantation has just been reported for the first time from the University of Pittsburgh in the American Journal of Transplantation. Earlier posts have focused on the emergence of a new Quality of Life Era of transplantation because of our ability to predictably overcome routine EARLY surgical and immunological challenges.  Rogal and collaborators now show that adequate depression treatment with medication(s) within the first year after liver transplantation for alcohol related disease is more strongly linked to the patient's survival at ten years than other risk factors. More strongly linked to survival at ten years than how ill the patient was at the time of transplant. More strongly linked to survival at ten years than the absence or presence of Hepatitis C.

Why is this so significant? Because it represents a factor that we may potentially improve to improve survival! The overall ten year survival rate following liver transplantation with a deceased donor organ is only 54%, far from what we would like it to be. Judging (extrapolating) from the 25% of patients in this study who were depressed but inadequately treated, the ability to intervene more favorably in one-quarter of transplant recipients could significantly impact the overall statistic. And forgetting about statistics for a moment, wouldn't it be wonderful to offer better therapy to each of those inadequately treated patients?

The question is how to accomplish the delivery of adequate care of a complex patient within the current healthcare environment? Transplant teams don't routinely deliver primary care for their patients and depend on local providers to do so. While psycho-social personnel are key team members, they usually focus most on the pre-transplant and early post-transplant issues. These new important data highlight a possible need to expand that emphasis or, at least, to improve the linkage and tracking of what is happening locally - consistent with the Accountable Care Organization model. Not easy to accomplish particularly without additional resources. Clearly, we will have to find a way.

If, as I suspect, the finding that the adequacy of depression treatment also extends to a strong linkage with long term survival following kidney and other transplant types, monitoring of the mental health medications and (perhaps) services will also require improved engagement by those respective transplant teams. Wow, a lot to chew on. But, at least we have a direction in which to go so that we can potentially make outcomes better.

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