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early signs of graft rejection, patiently participate in gradual physical rehabilitation,
and continue to work hard in their classes and non-restricted extracurricular activi-
ties. Maladaptively, they may never trust their parents, having outbursts and reject-
ing their help; they may show a lack of interest in knowing about their condition or
their medications, never learning how to maintain their own health when they move
out of their parents’ home; they may give up on school because they do not see a
purpose if they can no longer be an athlete; or they may push themself back into
strenuous physical activity too early because they cannot tolerate the frustratingly
slow recovery.
Another maladaptive psychological response that may occur during this stage is
“resistance to a state of health.” This usually happens to patients who have adapted
to a sick role for many years, and now a transplant challenges them to take on a new,
higher functioning role. A patient having difculty with this transition may feel
their care team is expecting a return to activity too soon, and they then feel over-
whelmed. Others may develop unexplained somatic symptoms or maintain a low-
level adherence to treatment in order to maintain a sick role [34].
12.3.1.3 Many Years Post-transplant
After several years, patients have not only been exposed to chronic immunosuppres-
sion, but they have also aged and may have developed new health problems. Chronic
graft rejection may occur. Patients may experience mental fatigue with maintaining
their health routine, undergo changes in medication regimen, and more fully realize
that transplant did not restore them to the level of health of their peers [33]. In this
stage, failure to adapt may result in loss of hope (or trust in the world), generativity
(or productivity), and ego integrity (or wisdom).
Example: A patient received a lung transplant for smoking-related COPD at
the age of 65, which interrupted their retirement plans to travel. They have
chronic graft rejection. Now 10 years later, they experience loss of hope as none
of the treatment changes their providers have recommended are changing the
course of their chronic graft rejection, loss of generativity as they now have
arthritis and feel guilty not being able to use the new lungs to live their fullest
life, and loss of ego integrity as they regret not having achieved their dream of
visiting every continent. Adaptively, they may persevere with their healthcare
team to seek solutions for their graft rejection symptoms, recognize that they
deserve a chance to live despite a likely behavioral cause of their lung disease,
nd satisfaction in prior achievements, and set realistic and satisfying future
goals despite their new mobility limitations. Maladaptively, they may cease
attending healthcare visits and experience gradual worsening of graft rejection,
thus afrming a hopeless outlook; they may feel someone else was more deserv-
ing of the organ and lose motivation to do anything; they may fail to recognize
the opportunities afforded to them by the transplant and instead feel they simply
traded one set of symptoms for another; and they may devalue their life achieve-
ments, experiencing chronic depression.
12 Mental Health intheAdult Solid Organ Transplant Recipient
368
12.3.2 Approach toBehavioral Management
inaTransplant Recipient
It is important to remember that maladaptive behaviors are not diagnostic of affec-
tive disorders, but they may uniquely avor an affective disorder that a transplant
recipient meets criteria for. However, poor coping is a direct contributor to affective
disorders post-transplant [35]. Therefore, we would recommend patients ideally
participate in a targeted behavioral therapy modality. The ACLP best practice guide-
line also suggests psychotherapy may be useful in treating SOT recipients with
depression, though its writers acknowledge that the decision to refer may take into
account availability of treatment, patient preferences, and patients’ cognitive and
physical ability to participate in psychotherapy [23].
Therapy modalities with the most evidence for efcacy include individual cogni-
tive behavioral therapy (CBT) [36] and group psychotherapy [37]. A more recent
systematic review of trials studying psychological treatment interventions in trans-
plant patients suggested that dynamic psychotherapy had the most positive impact
on mood disorders followed by CBT [38]. Since primary care centers may be
severely limited in providing these therapies, they may need to extrapolate the nd-
ings from the literature and apply psychotherapeutic intervention techniques infor-
mally during preventive visits or problem visits. Setting an agenda at the beginning
of a visit can provide structure to deliver and assess response to selected therapeutic
techniques.
A prospective study in kidney transplant recipients found that administering psy-
chotherapy focusing on specic recurring psychological themes in transplant recipi-
ents was associated with signicant reductions in depressive symptoms [36]. These
themes included fear of organ rejection, feelings of paradoxical loss despite suc-
cessful transplant, and psychological adaptation to having a new kidney. While this
study used a structured therapy approach and trained psychotherapists, a primary
care provider may still benet from aspects of the study. Most importantly, the study
emphasized the importance of focusing on individual characteristics of the patient
and the transplant-related themes the patient chose to mention. Furthermore, pri-
mary care providers may rely on the well-accepted nding that one of the most
important determinants of response to any psychotherapy is the quality of the
patient-provider relationship [39]. Therefore, a primary care provider may agree to
meet at somewhat regular intervals with the patient to discuss a patient’s pre-
ferred themes.
Peer mentorship has also been shown to be effective [40]. In a study of a multi-
faceted intervention including internet-based learning materials, vocational coun-
seling, and peer mentorship, not only did patients in the intervention group have
signicantly better quality of life and quality-adjusted treatment-free days but also
the intervention was cost-effective [41]. Some peer mentorship programs are avail-
able through online resources and are not exclusive to specic transplant centers,
G. Lenti etal.
369
making this a relatively accessible resource in the primary care setting. Experiences
with peer mentorship programs can be variable. Therefore, if contacting a program,
patients should be encouraged to ask questions about how the program provides
support to assess a match to their needs.
With the ever-expanding wealth of information on the internet, more studies are
needed to examine the impact of internet-delivered interventions for mental health
issues post-transplant. A study by Dew et al. found that a website developed for
heart transplant recipients was associated with improvements in quality of life and
medication adherence [42]. This may be partially attributable to patients feeling
they had more regular contact with educational material as well as with their care
team. Other behavioral interventions have been studied to improve depressive
symptoms (e.g., routine exercise, online health behavioral support, cell phone prob-
lem solving) [23], though more evaluation is needed to provide clear guidance on
their overall utility.
12.4 Management ofPost-transplant Medication
Non-adherence
A large meta-analysis of almost 150 studies involving all solid organ transplant
types showed that the average annual rate of medication non-adherence was about
23% of patients. In kidney recipients, the rate was 36% of patients [33]. The impacts
of non-adherence include poor quality of life, graft rejection and loss, healthcare
waste, and unjust distribution of limited resources. Because even a single missed
medication dose can lead to worse outcomes for the patient [43], treatment adher-
ence is a high priority in the follow-up care of transplant recipients. Non- adherence
may indicate not only undertreated psychiatric illness that warrants changes in phar-
macotherapy but also a lack of behavioral skills that warrants psychotherapy. Risk
factors for non-adherence include younger age, poor coping, poorer perceived self-
efcacy, poor social support, and poorer perceived health [44].
Several studies have identied effective interventions to improve medication
adherence, and they all give consideration to psychiatric comorbidity. Interventions
include multimodal collaborative approaches involving cognitive, educational, coun-
seling, and psychological interventions [45], creatively increasing patient autonomy
[46], motivational interviewing, and technology such as electronic pill monitoring or
automated reminders [47]. These interventions all utilize principles of cognitive
behavioral therapy. Primary care providers can engage patients in these interventions
by collaborating with the patient to create appropriate “homework,” then follow-up on
the task at the next visit. A key principle to this approach is to view uncompleted
homework not as a failure on the patient’s part but rather as an indication to adjust the
task to better t the patient’s needs. Importantly, medication adherence commonly
decreases over time due to increasing temporal distance of the patient from physical
consequences, necessitating a maintenance plan with regular follow-up.
12 Mental Health intheAdult Solid Organ Transplant Recipient
370
12.5 Management ofPsychiatric Side Effects
ofAnti-rejection Medications
Even following successful transplantation, new physical discomforts are likely
to result from side effects of immunosuppressive therapy. Some of the most
common immunosuppressive agent classes include calcineurin inhibitors (e.g.,
cyclosporine, tacrolimus), cell-mediated immune response inhibitors (e.g.,
mycophenolate mofetil), mammalian target of rapamycin (mTOR) inhibitors
(e.g., sirolimus), and corticosteroids (e.g., prednisone). These medications can
produce neurotoxic side effects, some of which are common psychiatric symp-
toms of depression or anxiety. Of these, calcineurin inhibitors and corticoste-
roids are the best-studied in their psychiatric effects. More research is needed to
parse out the contribution of other immunosuppressants to psychiatric side
effects, as many of them are only used in combination with corticosteroids and
calcineurin inhibitors.
Corticosteroids carry a dose-dependent risk of inducing psychiatric side
effects. A study in patients with asthma showed that the risk of psychiatric side
effects due to corticosteroids was low (1.3%) below 40 mg/day prednisone
equivalents, but severely increased (18.4%) at 80 mg/day prednisone equiva-
lents [48]. Mania is most common in the short-term period, but even low-dose
corticosteroids can produce depressive symptoms if used chronically [49].
Management of corticosteroid- induced psychiatric side effects ideally includes
tapering the dose. However, if a taper cannot be done, corticosteroid-induced
mania or hypomania can be managed with low doses of antipsychotics such as
olanzapine, and corticosteroid- induced depression can be managed with a selec-
tive serotonin reuptake inhibitor (SSRI) [50].
The calcineurin inhibitors, cyclosporine and tacrolimus, are similar in their neu-
rological and psychiatric side effects, but tacrolimus may be somewhat less likely to
produce these effects [51]. The psychiatric side effects include insomnia, vivid
dreams, anxiety, agitation, and psychosis. Severe side effects are experienced by up
to 12% of patients taking cyclosporine [52] and up to 8.4% of patients taking tacro-
limus [53], but risk is associated most strongly with higher serum levels. Therefore,
the mainstay of treatment is attempting a dose reduction and monitoring plasma
levels. For very serious neurological side effects, the medication may need to be
discontinued completely [54].
In the primary care setting, the initial management of potential neuropsychiatric
side effects of anti-rejection medications depends on the urgency of the presentation
as well as access to immediate consultation from a specialist who is prescribing the
medication. The transplant team typically manages immunosuppressive medica-
tions and should be consulted for any discussion of potential dose changes. In severe
cases, referral to emergency services may be necessary.
G. Lenti etal.
371
12.6 Psychiatric Issues inDelayed Graft Function
andinGraft Rejection
Chronic and end-stage organ disease predictably produces several physical symp-
toms that can cause new or exacerbate existing mental health disorders such as
depression and anxiety. Those physical symptoms include insomnia, fatigue, gas-
trointestinal distress, appetite change, pain, and many more.
Relief from these symptoms following transplant is often quick, even immediate,
as the normally functioning transplanted organ can quickly reverse metabolic
derangements [55]. Therefore, successful and relatively uncomplicated transplanta-
tion can relieve signicant mental burden.
However, some patients experience delayed graft function (the transplanted
organ is not immediately functioning at full or normal capacity) or graft rejection.
The return or persistence of pre-transplant physical symptoms any time after a
transplant may co-occur with worsening psychiatric symptoms. Therefore, worsen-
ing psychiatric symptoms should prompt providers to also review physical symp-
toms of graft rejection with the patient.
Approximately, 10–25% of kidney and liver transplant recipients experience
delayed graft function, and [56] 25–60% of kidney transplant recipients will experi-
ence acute graft rejection before 6months [57]. Others may experience chronic
rejection. The implications of these conditions include decreased metabolism of
medications, increased sensitivity to medication side effects, and possibly neuro-
psychiatric sequelae, which may require dose reduction in psychotropic medica-
tions. Patients may also require high doses of corticosteroids in the setting of graft
rejection, necessitating screening for common psychiatric side effects of high corti-
costeroid doses (mania, depression, and anxiety) and treatment with psychotropic
medications as necessary.
Many of the physical symptoms of chronic graft rejection overlap with symp-
toms of affective disorders, such as fatigue, insomnia, depressed mood, and appetite
changes. Graft rejection should be on the differential diagnosis of a transplant recip-
ient presenting with affective symptoms.
12.7 Pharmacologic Management ofDepression
When a patient with a history of solid organ transplant has depressive symptoms,
treatment should be guided by clinical assessment. Of patients who present with or
screen positive for depressive symptoms, some may t criteria for major depressive
disorder, while others may experience adjustment disorder or demoralization [23].
This clinical assessment and shared decision-making with the patient should guide
treatment options.
For patients who elect to pursue pharmacotherapy, the ACLP best practice guide-
line [23] recommends the following antidepressant regimens: selective serotonin
12 Mental Health intheAdult Solid Organ Transplant Recipient
372
reuptake inhibitors (SSRIs)—escitalopram, sertraline, and citalopram; or mirtazap-
ine. Escitalopram is a widely used antidepressant due to its generally favorable side
effect prole and low interaction with other medications. Sertraline’s use is sup-
ported by the Sertraline Antidepressant Heart-Attack Randomized Trial
(SADHART), which demonstrated its safety in the care of a medically complex,
frail patient population [58]. Mirtazapine is a good option for patients experiencing
insomnia and appetite suppression, both of which may be common in transplant
recipients, but is sometimes avoided in patients who have weight gain. Serotonin-
norepinephrine reuptake inhibitors (SNRIs) are also generally safe with few medi-
cation interactions and may be used as an alternative to SSRIs [14, 59], though we
would recommend avoiding high doses of venlafaxine (>225mg) due to risk of
hypertension. Bupropion may be benecial in transplant recipients who have
depression associated with anergia [14], though usually other agents are preferred
as rst line. Least preferred agents include monoamine oxidase inhibitors, tricyclic
antidepressants, and uvoxamine due to medication interactions and risk of side
effects in medically complex individuals [23].
12.8 Pharmacologic Management ofAnxiety
Specic guidance for treating anxiety in transplant recipients does not exist, though
primary care providers may approach treatment similarly to those with depressive
disorders discussed above. As in the general population, rst-line treatment for gen-
eralized anxiety disorder should be with SSRIs or SNRIs, which are generally well
tolerated with few drug interactions [14]. Sertraline in particular is also FDA-
approved as a rst line treatment of PTSD [14, 60].
Other anxiety treatment options or adjuncts fall in a variety of medication classes.
Buspirone may be effective in treating generalized anxiety disorder and can be used
as an adjunct or alternative to SSRIs and SNRIs [14]. Gabapentin has also been
shown to be benecial in a variety of anxiety-related conditions (off label), has few
undesirable drug interactions, and does not rely on hepatic metabolism [14]. As
such, gabapentin can be a good adjunct for patients already taking an SSRI or SNRI
who need further control of anxiety symptoms.
In SOT recipients who experience insomnia, providers should counsel on
improved sleep hygiene and cognitive behavioral therapy for insomnia (rst line),
though if pharmacologic therapy is needed, trazadone is generally a safe option.
Prazosin can also be used to help treat nightmares in individuals with PTSD or
medically induced trauma (off label).
Notably, some patients may experience short-term anxiety in the setting of
stressors related to transplant or medication related side effects. In scenarios of
acute or situational anxiety, providers may consider short-term use of benzodiaze-
pines, with appropriate consideration for risks including risk of substance use disor-
der and sedation [14]. For chronic anxiety disorders, providers should rely on the
aforementioned classes of medications.
G. Lenti etal.
373
As with treating depressive disorders, those with anxiety may also benet from
psychotherapy [38], though more research is needed to focus on the effectiveness of
psychotherapy for anxiety in organ transplant populations.
12.9 Behavioral andPharmacologic Management
ofSubstance Use Disorders
Substance use is a uniquely complex maladaptive behavior due to its combined
physical and psychological reinforcement. Substance use can pose unique chal-
lenges after transplant, as recovery is often non-linear, has several phases, and can
span long periods of time far out from transplant. Setbacks may happen and may not
only take the form of relapse, but also regressions of adaptive behavior or appear-
ance of new maladaptive behaviors to “replace” the substance use. Regular follow-
up with a trusted provider, as well as involvement in a supportive recovery
community, increases the chances of successful recovery via consistent engagement
with a caring network of people.
Patients in recovery experience developmental milestones, each with their own
set of growing pains and risks of relapse [61]. Steven Melemis, an addiction medi-
cine physician, describes four rules of relapse prevention that serve as a guide to
patients and their care providers to anticipate challenges in recovery. The rules are
as follows: (1) relapse is a gradual process with distinct stages, (2) recovery is a
process of personal growth with developmental milestones, (3) the main tools of
relapse prevention are cognitive therapy and mind-body relaxation, (4) most relapses
can be explained in terms of basic rules: (1) change your life, (2) be completely
honest, (3) ask for help, (4) practice self-care, (5) don’t bend the rules [61]. Even in
a primary care setting that may have limited mental health resources, the principles
of this paper can educate patients, families, and providers, guiding discussions dur-
ing appointments to be as therapeutic as possible. Community-based resources such
as Alcoholics Anonymous are also supported by evidence [62], highlighting the
importance of social support in recovery treatment in the transplant population.
With regard to pharmacotherapy, treatment depends on the particular use disor-
der. For alcohol use disorder (AUD), acamprosate, which undergoes minimal
hepatic metabolism and has no liver-related side effects, has been shown to be safe
in the post-liver transplant setting [63]. Acamprosate is renally cleared, so caution
should be used in patients with renal impairment. Naltrexone is also FDA-approved
for treatment of alcohol use disorder, though should be used with caution for patients
with end-stage liver disease or those with concurrent opioid use [64]. While naltrex-
one carries a risk for hepatotoxicity, several recent studies support the safety of
naltrexone in patients with liver disease, including those with cirrhosis [65, 66]. As
such, for patients who have had a successful liver transplant, naltrexone should be
safe to use with close monitoring.
Treatment of opioid use disorder (OUD) is not signicantly different in the SOT
population compared to the general population, and patients should be offered
12 Mental Health intheAdult Solid Organ Transplant Recipient
374
medications for opioid use disorder (methadone or buprenorphine) when indicated.
For patients with OUD undergoing transplant, the peri-transplant period may pose
unique challenges with pain control and opioid agonist management. When able,
teams should enlist the help of pain management and addiction medicine specialists
to guide treatment during this time. Primary care providers should collaborate with
addiction medicine teams following transplant to avoid interruptions in opioid ago-
nist treatment and stability [67].
Other substance use disorders outside of AUD and OUD have less supporting
evidence to dictate clear treatment plans. As such, for patients presenting with other
types of use disorders (e.g., methamphetamine use disorder), primary care providers
should refer patients to addiction medicine specialists for treatment.
Patients who struggle to maintain remission of a substance use disorder despite
pharmacologic and behavioral health interventions provided in the primary care set-
ting should be referred to addiction medicine, psychiatry, or social work to explore
more intensive resources, including intensive outpatient therapy or inpatient
rehabilitation.
12.10 Coordination andReferral
There are more than 250 solid organ transplant centers in the United States [68].
The percentage of these that have embedded psychiatry care is rising in response to
the increased mental health demands of the increasing number of transplant candi-
dates and recipients. However, the psychiatric resources in a given transplant center
may range from a single provider with limited clinic time to a team of several pro-
viders and rotating trainees. The total population served by a transplant center also
varies greatly. Ideally, care of a transplant recipient is highly interdisciplinary, and
mental health specialists are part of the team. However, due to resource constraints,
many patients rely on their primary care provider as the principal manager of their
post-transplant care, including mental health care.
When accepting a new patient with a history of organ transplant into a primary
care practice or re-establishing primary management of a patient who was tempo-
rarily managed by a transplant center, it is important to clarify with the discharging
transplant team what resources will be available to both patient and provider. This
includes specialists who plan to continue follow-up, social support services, and
criteria for re-referral to organ specic specialists. This will help primary care pro-
viders anticipate situations that warrant referral no matter how long it takes, as the
primary care provider will still need to manage care until then.
In this chapter, we did not discuss primary care management of “serious mental
illness” (SMI), including depression with suicidal behavior, bipolar disorder, psy-
chosis, severe personality disorders, and certain substance use disorders. A study of
over 800 veterans with solid organ transplants found that 17% had schizophrenia,
bipolar disorder, severe depression, or severe PTSD [69]. Remarkably there was no
difference in mortality at 3-years post-transplant when compared to patients with no
G. Lenti etal.
375
psychiatric diagnosis, but poor outcomes were associated with suboptimal manage-
ment of the SMI.Therefore, early referral to psychiatrists and therapists can ease
the burden of the heavy care needs of patients with SMI.Another vital referral
source for a primary care provider to be familiar with in their geographic area is
community mental health agencies. These organizations can provide access to phar-
macotherapy, psychotherapy, and case management, the latter of which is instru-
mental for patients with SMI to manage their complex psychiatric care. Certain
substance use disorders, including stimulant and opioid use disorders, can benet
from referral to addiction psychiatry if specialized evidence-based treatments—
medication-assisted treatment, routine laboratory monitoring, and behavioral treat-
ment such as contingency-management—have limited availability in primary care.
A growing mental health resource in primary care settings is “integrated care.”
This term refers to behavioral health care incorporated into a primary care setting,
ranging from minimally collaborative models where the mental health providers are
located separately from primary care, to fully integrated where the providers prac-
tice in the same facility and constantly communicate with one another in a system-
atic way. There are over 100 randomized controlled trials demonstrating the
superiority of integrated care models over usual care in treatment of depression and
other mental health disorders [70]. Integrated care programs can increase access to
mental healthcare for many subsets of patients with psychiatric illness, and trans-
plant recipients can benet greatly. The integrated system takes time, resources, and
concerted effort to implement into a primary care practice, so if it is not already
available, this will not be usable in the short term. However, if a primary care prac-
tice includes high numbers of patients needing specialty mental healthcare, as in the
transplant population, the practice may be justied in proposing an integrated care
implementation plan and applying for funding to secure adequate mental health
resources for their complex psychiatric patients. Healthcare centers pioneering the
eld of integrated care offer implementation support for interested practitioners.
12.11 Conclusion
In summary, mental health disorders are very common in the solid organ transplant
population, and general practitioners are well positioned to diagnose and treat these
disorders in the primary care setting. Given the high prevalence of mental illness
among transplant recipients, understanding a patient’s risk factors and screening for
mental health disorders in the post-transplant period is critical. For most patients,
primary care providers should feel empowered to employ behavioral management
techniques and to treat SOT recipients with medications for mental health disorders
when indicated. Referral should be placed for patients with serious mental illness,
though integrated mental healthcare in primary care clinics is growing and may
provide support for patients and providers tackling complex mental health treatment
challenges. While more research and resources are needed, primary care providers
will continue to remain a pillar of support in the mental healthcare of solid organ
transplant recipients.
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376
References
1. Lee B, Wang Y, Carlson SA, Greenlund KJ, Lu H, Liu Y, etal. National, state-level, and county-
level prevalence estimates of adults aged >/=18 years self-reporting a lifetime diagnosis of
depression—United States, 2020. MMWR Morb Mortal Wkly Rep. 2023;72(24):644–50.
https://doi.org/10.15585/mmwr.mm7224a1. Epub 20230616. PubMed PMID: 37318995;
PubMed Central PMCID: PMC10328468.
2. Rogal SS, Landsittel D, Surman O, Chung RT, Rutherford A. Pretransplant depres-
sion, antidepressant use, and outcomes of orthotopic liver transplantation. Liver Transpl.
2011;17(3):251–60. https://doi.org/10.1002/lt.22231. PubMed PMID: 21384507; PubMed
Central PMCID: PMC3078692.
3. Jinjuvadia R, Jinjuvadia C, Puangsricharoen P, Chalasani N, Crabb DW, Liangpunsakul S,
et al. Concomitant psychiatric and nonalcohol-related substance use disorders among hos-
pitalized patients with alcoholic liver disease in the United States. Alcohol Clin Exp Res.
2018;42(2):397–402. https://doi.org/10.1111/acer.13567. Epub 20180101. PubMed PMID:
29197092; PubMed Central PMCID: PMC5785413.
4. Ewusi-Mensah I, Saunders JB, Wodak AD, Murray RM, Williams R.Psychiatric morbidity in
patients with alcoholic liver disease. Br Med J (Clin Res Ed). 1983;287(6403):1417–9. https://
doi.org/10.1136/bmj.287.6403.1417. PubMed PMID: 6416437; PubMed Central PMCID:
PMC1549651.
5. Rogal SS, Mankaney G, Udawatta V, Chinman M, Good CB, Zickmund S, etal. Pre-transplant
depression is associated with length of hospitalization, discharge disposition, and survival
after liver transplantation. PLoS One. 2016;11(11):e0165517. https://doi.org/10.1371/jour-
nal.pone.0165517. Epub 20161107. PubMed PMID: 27820828; PubMed Central PMCID:
PMC5098732.
6. Doyle T, Schmidt B, Scaglione S.Prevalence of depression and anxiety symptoms by liver
disease etiology. Clin Liver Dis (Hoboken). 2023;22(3):89–94. https://doi.org/10.1097/
CLD.0000000000000068. Epub 20230711. PubMed PMID: 37799635; PubMed Central
PMCID: PMC10550025.
7. Corruble E, Barry C, Varescon I, Durrbach A, Samuel D, Lang P, et al. Report of depres-
sive symptoms on waiting list and mortality after liver and kidney transplantation: a prospec-
tive cohort study. BMC Psychiatry. 2011;11:182.
https://doi.org/10.1186/1471- 244X- 11- 182.
Epub 20111121. PubMed PMID: 22103911; PubMed Central PMCID: PMC3231871.
8. Rosenberger EM, DiMartini AF, DeVito Dabbs AJ, Bermudez CA, Pilewski JM, Toyoda Y,
etal. Psychiatric predictors of long-term transplant-related outcomes in lung transplant recipi-
ents. Transplantation. 2016;100(1):239–47. https://doi.org/10.1097/TP.0000000000000824.
PubMed PMID: 26177087; PubMed Central PMCID: PMC4684444.
9. Delibasic M, Mohamedali B, Dobrilovic N, Raman J.Pre-transplant depression as a predic-
tor of adherence and morbidities after orthotopic heart transplantation. J Cardiothorac Surg.
2017;12(1):62.
https://doi.org/10.1186/s13019- 017- 0626- 0. Epub 20170725. PubMed PMID:
28743270; PubMed Central PMCID: PMC5526318.
10. Maldonado JR, Sher Y, Lolak S, Swendsen H, Skibola D, Neri E, et al. The Stanford inte-
grated psychosocial assessment for transplantation: a prospective study of medical and
psychosocial outcomes. Psychosom Med. 2015;77(9):1018–30. https://doi.org/10.1097/
PSY.0000000000000241. PubMed PMID: 26517474.
11. Hasin DS, O’Brien CP, Auriacombe M, Borges G, Bucholz K, Budney A, et al. DSM-5
criteria for substance use disorders: recommendations and rationale. Am J Psychiatry.
2013;170(8):834–51. https://doi.org/10.1176/appi.ajp.2013.12060782. PubMed PMID:
23903334; PubMed Central PMCID: PMC3767415.
12. Winder GS, Shenoy A, Dew MA, DiMartini AF.Alcohol and other substance use after liver
transplant. Best Pract Res Clin Gastroenterol. 2020;46–47:101685. https://doi.org/10.1016/j.
bpg.2020.101685. Epub 20200914. PubMed PMID: 33158473.
G. Lenti etal.