Maher Ayyash¹, Jennifer Steel^1,2, Adam Tripp¹, Brandon Stone³, Dolly Martin⁴, Kareem Abu-Elmagd²

¹Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; ²Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; ³University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; ⁴University of Pittsburgh Medical Center, Pittsburgh, PA, United States

Background: The aims of this study were to (1) assess the prevalence of past and current psychiatric disorders, (2) examine the association between indication for transplant and psychiatric disorders, and (3) assess the prevalence of health behaviors such as substance use.

Methods: A comprehensive psychiatric evaluation was performed with 116 patients who presented to the University of Pittsburgh’s Thomas E. Starzl Transplantation Institute/Intestinal Rehabilitation and Transplant Center between September 2004 and September 2006.

Results: Of the 116 patients, 86% of the patients met criteria for DSM-IV psychiatric diagnoses. Sixty-one percent of the patients were diagnosed with a mood disorder, 29% with an anxiety disorder, 16% with alcohol or drug dependence, 6% with a sleep disorder, 6% with somatoform disorder, 2% with delirium, 2% with an eating disorder, and 1% with a psychotic disorder. Mood disorders were observed more frequently in candidates who were diagnosed with short bowel or renal insufficiency while anxiety disorders were diagnosed more frequently in candidates with Crohn’s or a coagulation disorders or who experienced traumatic injury requiring a transplant. Candidates with liver cirrhosis had higher rates of substance dependence disorders. Patients with short bowel also had higher rates of delirium at the time of their first evaluation. Forty-nine percent of pre-transplant patients reported nicotine dependence and 40% reported pain at the time of evaluation.

Conclusions: Candidates awaiting transplantation for small bowel or multivisceral transplant had higher rates of psychiatric disorders when compared to the general population and other transplant candidates. Further research is warranted to understand the predictors of psychiatric morbidity and the development of behavioral and pharmacological interventions to reduce the psychiatric morbidity in this population is warranted.