Annotated Abstracts of Journal Articles
2015, 1st Quarter

Transplant Psychiatry

Annotations by Paula Zimbrean, MD, FAPM
March 2015

Delirium affects length of hospital stay after lung transplantation

Also of interest:

Sommer IE, van Bekkum DW, Klein H, et al: Severe chronic psychosis after allogeneic SCT from a schizophrenic sibling
Bone Marrow Transplant 2015; 50(1):153-4This is a fascinating case of a 67-year-old man who received an allogeneic bone transplantation for leukemia from his brother who had a diagnosis of schizophrenia. Four months later, the patient developed chronic severe psychosis with negative medical work-up, which persisted after discontinuation of immunosuppressant medications. The information presented originates from a multidisciplinary long-term (3 years) follow-up of this patient; however this is a single case report, so conclusions are limited.
This case raises the question of the immunological mechanism of schizophrenia.

PUBLICATION #1 — Transplant Psychiatry

Delirium affects length of hospital stay after lung transplantation

Smith PJ, Rivelli SK, Waters AM, Hoyle A, Durheim MT, Reynolds JM, et al
J Crit Care 2015 Feb; 30(1):126-9

ANNOTATION (Paula Zimbrean)

The Finding: Poorer cognitive function before transplant was associated with greater risk of delirium, whereas demographic and medical predictors were not. For every standard deviation increase in performance on cognitive testing , there was a 31% decrease in the odds of developing delirium after transplantation. In addition, it was found that the presence and duration of delirium were predictive of longer hospital stays after transplantation.

Strength and Weaknesses: This is a prospective study of lung transplant recipients aimed at assessing the correlation between pretransplant cognitive status and posttransplant delirium in lung transplant recipients. Patients underwent systematic cognitive testing pretransplantation and were followed closely posttransplant to identify delirium. The limitations of the study consist in a relatively small sample size, the fact that one-quarter of participants were unable to complete pretransplant cognitive assessments, limited length of follow up, and inability to collect data on intraoperative predictors of delirium, including hemodynamic changes and intraoperative hypoxia.

Relevance: This study provides helpful information about the prevalence, risk factors, and cost impact of delirium in lung transplant recipients.

ABSTRACT (PubMed)

Background: Delirium is relatively common after lung transplantation, although its prevalence and prognostic significance have not been systematically studied. The purpose of the present study was to examine pretransplant predictors of delirium and the short-term impact of delirium on clinical outcomes among lung transplant recipients.

Methods: Participants underwent pretransplant cognitive testing using the Repeatable Battery for the Assessment of Neuropsychological Status and the Trail Making Test. After transplant, delirium was assessed using the Confusion Assessment Method until discharge.

Results: Sixty-three patients were transplanted between March and November 2013, of which 23 (37%) developed delirium. Among transplanted patients, 48 patients completed pretransplant cognitive testing. Better pretransplant cognitive function was associated with lower risk of delirium (odds ratio, 0.69 [95% confidence interval 0.48, 0.99], P = .043); and demographic and clinical features including native disease (P = .236), the Charlson comorbidity index (P = .581), and the lung allocation score (P = .871) were unrelated to risk of delirium, although there was a trend for women to experience delirium less frequently (P = .071). The presence (P = .006) and duration (P = .027) of delirium were both associated with longer hospital stays.

Conclusion: Delirium occurs in more than one-third of patients after lung transplantation. Delirium was associated with poorer pretransplant cognitive functioning and longer hospital stays, after accounting for other medical and demographic factors.