Early post-transplant medical compliance and mental health predict physical morbidity and mortality one to three years after heart transplantation

Background: Poor medical compliance has been held responsible for a large p roportion of deaths occurring subsequent to initial postoperative recovery. However, beyond clinical reports, there has been little empirical examinat ion of this issue, or of the extent to which major psychiatric disorder and failure to adjust to the transplant predict long-term physical morbidity a nd mortality. We prospectively examined whether a full range of compliance behaviors and psychiatric outcomes during the first year posttransplant pre dicted subsequent mortality and physical morbidity through 3 years posttran splant. Methods: A total of 145 heart recipients who had received detailed complian ce and mental health assessments during the first year post-transplant were followed up at 3 years post-transplant. Interview data and corroborative i nformation from family members were used to determine compliance in multipl e domains, psychiatric diagnoses, and psychiatric symptomatology during the first year post-surgery. Medical record reviews were performed to abstract data on acute graft rejection episodes, incident cardiac allograft disease (CAD) and mortality from 1 to 3 years posttransplant. Results: After controlling for known transplant-related predictors of outco me, multivariate analyses yielded the following significant (p < 0.05) resu lts: (a) risk of acute graft rejection was 4.17 times greater among recipie nts who were not compliant with medications; (b) risk of incident CAD was e levated by persistent depression (Odds Ratio, OR = 4.67), persistent anger- hostility (OR = 8.00), medication noncompliance (OR = 6.91), and obesity (O R = 9.92); and (c) risk of mortality was increased if recipients met criter ia for Post-Traumatic Stress Disorder related to the transplant (OR = 13.74 ). Conclusions: The findings, plus data we have previously reported that showe d which patients are most likely to have compliance and psychiatric problem s early posttransplant, suggest that interventions focused on maximizing pa tients' psychosocial status in these areas may further improve long-term ph ysical health outcomes in this population.