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Original Research: Transplantation |

Neurobehavioral Functioning and Survival Following Lung TransplantationNeurobehavioral Functioning and Survival

Patrick J. Smith, PhD; James A. Blumenthal, PhD; Robert M. Carney, PhD; Kenneth E. Freedland, PhD; C. Virginia F. O’Hayer, PhD; Elbert P. Trulock, MD, FCCP; Tereza Martinu, MD; Todd A. Schwartz, DrPH; Benson M. Hoffman, PhD; Gary G. Koch, PhD; R. Duane Davis, MD; Scott M. Palmer, MD, FCCP
Author and Funding Information

From the Department of Psychiatry and Behavioral Sciences (Drs Smith, Blumenthal, and Hoffman), Department of Medicine (Drs Martinu and Palmer), and Department of Surgery (Dr Davis), Duke University Medical Center, Duke University Health System, Durham, NC; Washington University School of Medicine in St. Louis (Drs Carney, Freedland, and Trulock), St. Louis, MO; College of Medicine, Drexel University (Dr O’Hayer), Philadelphia, PA; and Department of Biostatistics (Drs Schwartz and Koch), UNC Gillings School of Global Public Health, Chapel Hill, NC.

Correspondence to: Patrick J. Smith, PhD, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3119, Durham, NC 27710; e-mail: patrick.j.smith@dm.duke.edu


Funding/Support: This study was supported by the National Heart, Lung, and Blood Institute [Grants HL65503-01 and HL065503-06]. Also, this work was supported in part by the Health Resources and Services Administration [contract 234-2005-37011C].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(3):604-611. doi:10.1378/chest.12-2127
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Background:  Neurobehavioral functioning is widely recognized as being an important consideration in lung transplant candidates, but little is known about whether these factors are related to clinical outcomes. The present study examined the relationship of neurobehavioral functioning, including measures of executive function and memory, depression, and anxiety, to long-term survival among lung transplant recipients.

Methods:  The sample was drawn from 201 patients who underwent transplantation at Duke University and Washington University who participated in a dual-site clinical trial investigating medical and psychosocial outcomes in transplant candidates with end-stage lung disease. All patients completed the Beck Depression Inventory-II (BDI-II) and Spielberger State-Trait Anxiety Inventory at baseline and again after 12 weeks, while a subset of 86 patients from Duke University also completed neurocognitive testing. Patients were followed for survival up to 12 years after completing baseline assessments.

Results:  One hundred eleven patients died over a mean follow-up of 10.8 years (SD = 0.8). Baseline depression, anxiety, and neurocognitive function were examined as predictors of posttransplant survival, controlling for age, 6-min walk distance, FEV, and native disease; education and cardiovascular risk factors were also included in the model for neurocognition. Lower executive function (hazard ratio [HR] = 1.09, P = .012) and memory performance (HR = 1.11, P = .030) were independently associated with greater mortality following lung transplant. Although pretransplant depression and anxiety were not predictive of mortality, patients who scored > 13 on the BDI-II at baseline and after 3 months pretransplant had greater mortality (HR = 1.85 [95% CI, 1.04, 3.28], P = .036).

Conclusions:  Neurobehavioral functioning, including persistently elevated depressive symptoms and lower neurocognitive performance, was associated with reduced survival after lung transplantation.

Trial registry:  ClinicalTrials.gov; No.: NCT00113139; URL: www.clinicaltrials.gov

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