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Adjudication committee
- First opponent: Associate Professor Fabienne Dobbels, KU Leuven University
- Second opponent: Professor Anders Lund, University of Bergen
- Third member and chair of the evaluation committee: Professor Jan Ivar Røssberg, University of Oslo
Chair of the Defence
Professor Odd Geiran, University of Oslo
Principal Supervisor
Professor Stein Andersson, University of Oslo
Summary
Mood and Cognitive Outcome after Heart Transplantation: The MOODHEART study
Posttransplant psychosocial factors may affect the clinical course after heart transplantation (HTx). Therefore, we aimed to increase existing knowledge of cognitive function after HTx and of self-reported posttransplant depressive symptomatology associated with outcomes.
We assessed cognitive function in 37 medium- and 37 long-term survivors of HTx by means of neuropsychological assessment on average 3.2 and 20.3 years after HTx. Both samples were recruited from cohorts of HTx recipients, previously established at the Norwegian national transplant centre. Furthermore, we conducted a secondary analysis on 141 HTx recipients of one of these cohorts to examine the long-term impact of posttransplant depression on mortality.
Impaired cognitive performance was frequent on several measures, both among medium- and long-term survivors, with 39.4% of the medium- and 31.4% of the long-term survivors exhibiting impairment on at least one of five cognitive domains. Among the medium-term survivors, which had been randomized to one of two immunosuppressive regimens at time of HTx, cognitive function did not differ in a clinically relevant manner between treatment groups. Among the long-term survivors, patients with Mild Cognitive Impairment had a lower mean haemoglobin than those without.
Clinically significant depression assessed on average 5.6 years after HTx, predicted mortality in uni- and multivariate Cox regression analyses during follow-up for up to 18.6 years. Supplementary analyses indicated that a cognitive-affective and a somatic-affective symptom dimension of depression might exist, but their clinical utility and predictive validity remained unsettled.
Our results argue for the need of regular assessment of cognitive function and depressive symptoms after HTx to facilitate tailored clinical follow-up. Our results also argue for the need of further research on posttransplant psychosocial risk factors for poor outcomes in order to develop evidence-based interventions.
Additional information
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