Psychiatric consultation in the context of heart transplantation

Author/s Valentina Martinelli, Amanda Magliano, Serena Scalmati, Pierluigi Politi
Publishing Year 2022 Issue 2022/2 Language Italian
Pages 19 P. 41-59 File size 201 KB
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Heart transplantation (HT) currently represents a well-established surgical procedure and is considered the treatment of choice in case of terminal cardiac insufficiency refractory to medical or surgical therapies. HT raises unique psychological issues which originate from the complexity of the clinical and therapeutic trajectory, from the extraordinary simbolicity of the heart, from the human source of the graft. Symptoms of psychological distress as well as psychiatric disorders, mainly mood and anxiety disorders, are common both in the pre- and post-transplant phase, with prevalence rates of 50% in HT candidates and 20-30% in recipients, even in the long term. Correct detection and treatment of these conditions is mandatory to guarantee optimal HT outcome in the long term.

Keywords: Heart transplant, psychopathology, depression, anxiety, delirium, psychotherapy, psychological aspects.

  1. Barnard CN. A human cardiac transplant: an BarBarnard CN. A human cardiac transplant: an interim report of a successful operation performed at Grote Schuur Hospital, Cape Town. South Africa Medical Journal 1967; 41: 1271-1274.
  2. Javier MFDM, Javier Delmo EM, Hetzer R. Evolution of heart transplantation since Barnard's first. Cardiovascular Diagnosis and Therapy 2021; 11: 171-182.
  3. Sánchez R, Baillès E, Peri JM, Bastidas A, Pérez-Villa F, Bulbena A, Pintor
  4. L. Assessment of psychosocial factors and predictors of psychopathology in a sample of heart transplantation recipients: a prospective 12-month follow-up. General Hospital Psychiatry 2016; 38: 59-64.
  5. Castelnuovo-Tedesco P. Ego vicissitudes in response to replacement or loss of body parts. Certain analogies to events during psychoanalytic treatment. The Psychoanalytic Quarterly 1978; 47: 381-97.
  6. Politi P, Martinelli V. Cardiac Transplantation and Psychopathology. In: Govoni S, Politi P, Vanoli E. (Eds). Brain and Heart Dynamics. Springer, Cham ed.; 2020. pp 399-409.
  7. Blacher R. Death, Resurrection, and Rebirth: Observations in Cardiac Surgery. The Psychoanalytic Quarterly 1983; 52: 56-72.
  8. Levenson JL, Olbrisch ME. Psychiatric aspects of heart transplantation. Psychosomatics 1993; 34: 114-23.
  9. Mauthner OE, De Luca E, Poole JM, Abbey SE, Shildrick M, Gewarges M, Ross HJ. Heart transplants: Identity disruption, bodily integrity and interconnectedness. Health 2015; 19: 578-9.
  10. Castelnuovo-Tedesco P. Transplantation. Psychological Implications of Changes in Body Image. In: Levy NB. (Eds) Psychonephrology. Boston, MA: Springer ed.; 1981.
  11. Freud S. L’Io e l’Es. In Musatti C. Opere di Sigmund Freud. Torino: Bollati Boringhieri Editore; 2000. Vol. 9.
  12. Centro Nazionale Trapianti. Report 2021- sintesi. Donazione e trapianto di organi, tessuti e cellule staminali emopoietiche, -- https://www.trapianti.salute.
  13. Alraies MC, Eckman P. Adult heart transplant: indications and outcomes. Journal of Thoracic Disease 2014; 6: 1120-1128.
  14. International Society for Heart and Lung Transplantation. International Thoracic Organ Transplant (TTX) Registry 2021 Data Slides. Adult Heart Transplantation Focus Theme, --
  15. Wynn F. Reflecting on the ongoing aftermath of heart transplantation: Jean- Luc Nancy's L'intrus. Nursing Inquiry 2009; 16: 3-9.
  16. Dew MA, DiMartini AF, Dobbels F, Grady KL, Jowsey-Gregoire SG, Kaan A, et al. The 2018 ISHLT/APM/AST/ICCAC/STSW recommendations for the psychosocial evaluation of adult cardiothoracic transplant candidates and candidates for long-term mechanical circulatory support. Journal of Heart and Lung Transplantation 2018; 37: 803-823
  17. Maldonado JR, Dubois HC, David EE, Sher Y, Lolak S, Dyal J, Witten D. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT): a new tool for the psychosocial evaluation of pre-transplant candidates. Psychosomatics 2012; 53: 123-32.
  18. Spaderna H, Smits JM, Rahmel AO, Weidner G. Psychosocial and behavioural factors in heart transplant candidates-an overview. Transplant International 2007; 20: 909-20.
  19. Delibasic M, Mohamedali B, Dobrilovic N, Raman J. Pre-transplant depression as a predictor of adherence and morbidities after orthotopic heart
  20. transplantation. Journal of Cardiothoracic Surgery 2017; 12(1): 62.
  21. Burker EJ, Madan A, Evon D, Finkel JB, Mill MR. Educational level, coping, and psychological and physical aspects of quality of life in heart transplant candidates. Clinical Transplantation 2009; 23: 233-40.
  22. Spaderna H, Zittermann A, Reichenspurner H, Ziegler C, Smits J, Weidner G. Role of Depression and Social Isolation at Time of Waitlisting for Survival 8 Years After Heart Transplantation. Journal of the American Heart Association 2017; 6(12): e007016.
  23. Olbrisch ME, Levenson JL, Hamer R. The PACT: a rating scale for the study of clinical decision-making in psychosocial screening of organ transplant candidates. Clinical Transplantation 1989; 3: 164-9.
  24. Twillman RK, Manetto C, Wellisch DK, Wolcott DL. The Transplant Evaluation Rating Scale. A revision of the psychosocial levels system for evaluating organ transplant candidates. Psychosomatics 1993; 34: 144-53.
  25. Bottesi G, Granziol U, Forza G, Volpe B, Feltrin A, Battermann F, et al. The Psychosocial Assessment of Transplant Candidates: Inter-Rater Reliability and Predictive Value of the Italian Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT). Psychosomatics 2020; 61: 127-134.
  26. Centro Nazionale Trapianti. Report 2019- sintesi. Donazione e trapianto di organi, tessuti e cellule staminali emopoietiche, -- https://www.trapianti.salute.
  27. Sánchez R, Baillés E, Peri JM, Bastidas A, Pérez-Villa F, Bulbena A, Pintor L. Cross-sectional psychosocial evaluation of heart transplantation candidates. General Hospital Psychiatry 2014; 36: 680-5.
  28. Doehner W, Ural D, Haeusler KG, Čelutkienė J, Bestetti R, Cavusoglu Y, et al. Heart and brain interaction in patients with heart failure: overview and proposal for a taxonomy. A position paper from the Study Group on Heart and Brain Interaction of the Heart Failure Association. European Journal of Heart Failure 2018; 20: 199-215.
  29. Heilmann C, Kuijpers N, Beyersdorf F, Berchtold-Herz M, Trummer G, Stroh AL, Schlensak C, Fritzsche K.Supportive psychotherapy for patients with heart transplantation or ventricular assist devices. European Journal of Cardio- Thoracic Surgery 2011; 39: 44-50.
  30. Baba A, Hirata G, Yokoyama F, Kenmoku K, Tsuchiya M, Kyo S, Toyoshima R. Psychiatric problems of heart transplant candidates with left ventricular assist devices. Journal of Artificial Organs 2006; 9: 203-8.
  31. Caro MA, Rosenthal JL, Kendall K, Pozuelo L, Funk MC What the Psychiatrist Needs to Know About Ventricular Assist Devices: A Comprehensive Review. Psychosomatics 2016; 57: 229-37.
  32. Sokoreli I, de Vries JJ, Pauws SC, Steyerberg EW. Depression and anxiety as predictors of mortality among heart failure patients: systematic review and meta-analysis. Heart Failure Reviews 2016; 21: 49-63.
  33. Crone CC, Gabriel GM. Treatment of anxiety and depression in transplant patients: pharmacokinetic considerations. Clinical Pharmacokinetics 2004; 43: 361-94.
  34. Ackerman MG, Shapiro PA. Psychological Effects of Invasive Cardiac Surgery and Cardiac Transplantation. In: Alvarenga M, Byrne D. (Eds). Handbook of Psychocardiology. Singapore: Springer; 2016.
  35. Alejaldre A, Delgado-Mederos R, Santos MÁ, Martí-Fàbregas J. Cerebrovascular complications after heart transplantation. Current Cardiology Reviews 2010; 6: 214-7.
  36. Ibrahim K, McCarthy CP, McCarthy KJ, Brown CH, Needham DM, Januzzi JL Jr, et al. Delirium in the Cardiac Intensive Care Unit. Journal of the American Heart Association 2018; 7: e008568.
  37. Anderson BJ, Chesley CF, Theodore M, Christie C, Tino R, Wysoczanski A, et al. Incidence, risk factors, and clinical implications of post-operative delirium in lung transplant recipients. Journal of Heart and Lung Transplantation 2018; 37: 755-762.
  38. Dew MA, DiMartini AF. Psychological disorders and distress after adult cardiothoracic transplantation. Journal of Cardiovascular Nursing 2005; 20: S51-66.
  39. Poole J, Ward J, DeLuca E, Shildrick M, Abbey S, Mauthner O, Ross H. Grief and loss for patients before and after heart transplant. Heart & Lung 2016; 45: 193-8.
  40. Conway A, Schadewaldt V, Clark R, Ski C, Thompson DR, Doering L. The psychological experiences of adult heart transplant recipients: a systematic review and meta-summary of qualitative findings. Heart & Lung 2013; 42: 449-55.
  41. Dew MA, Kormos RL, DiMartini AF, Switzer GE, Schulberg HC, Roth LH, Griffith BP. Prevalence and risk of depression and anxiety-related disorders during the first three years after heart transplantation. Psychosomatics 2001; 42: 300-13.
  42. Dew MA, Roth LH, Thompson ME, Kormos RL, Griffith BP. Medical compliance and its predictors in the first year after heart transplantation. Journal of Heart and Lung Transplantation 1996; 15: 631-45.
  43. International Society for Heart and Lung Transplantation (ISHLT). International Thoracic Organ Transplant (TTX) Registry, -- ttx-registry.
  44. Favaro A, Gerosa G, Caforio AL, Volpe B, Rupolo G, Zarneri D,et al.
  45. Posttraumatic stress disorder and depression in heart transplantation recipients the relationship with outcome and adherence to medical treatment. General Hospital Psychiatry 2011; 33: 1-7.
  46. Politi P, Piccinelli M, Fusar-Poli P, Klersy C, Campana C, Goggi C, et al. Ten years of "extended" life: quality of life among heart transplantation survivors. Transplantation 2004; 78: 257-63.
  47. Dobbels F, De Geest S, Martin S, Van Cleemput J, Droogne W, Vanhaecke J. Prevalence and correlates of depression symptoms at 10 years after heart transplantation: continuous attention required. Transplant International 2004; 17: 424-31.
  48. Fusar-Poli P, Martinelli V, Klersy C, Campana C, Callegari A, Barale F, et al. Depression and quality of life in patients living 10 to 18 years beyond heart transplantation. Journal of Heart and Lung Transplantation 2005; 24: 2269-78.
  49. Conway A, Sheridan J, Maddicks-Law J, Fulbrook P, Ski CF, Thompson DR, et al. Depression and Pain in Heart Transplant Recipients: An Observational Study. Biological Research For Nursing 2017; 19: 71-76.
  50. Dew MA, Rosenberger EM, Myaskovsky L, DiMartini AF, DeVito Dabbs AJ, Posluszny DM et al. Depression and Anxiety as Risk Factors for Morbidity and Mortality After Organ Transplantation: A Systematic Review and Meta- Analysis. Transplantation 2015; 100: 988-1003.
  51. Cupples S, Dew MA, Grady KL, De Geest S, Dobbels F, Lanuza D, Paris W. Report of the Psychosocial Outcomes Workgroup of the Nursing and Social Sciences Council of the International Society for Heart and Lung Transplantation: present status of research on psychosocial outcomes in cardiothoracic transplantation: review and recommendations for the field. Journal of Heart and Lung Transplantation 2006; 25: 716-25.
  52. Shamaskin AM, Rybarczyk BD, Wang E, White-Williams C, McGee E Jr, Cotts W, et al. Older patients (age 65+) report better quality of life, psychological adjustment, and adherence than younger patients 5 years after heart transplant: A multisite study. Journal of Heart and Lung Transplantation 2012; 31: 478-84.
  53. Michaelsen K, Arnold RM. Treating depression after heart transplantation Journal of Palliative Medicine 2013; 16: 1477-8.
  54. Conway A, Schadewaldt V, Clark R, Ski C, Thompson DR, Kynoch K, Doering L. The effectiveness of non-pharmacological interventions in improving psychological outcomes for heart transplant recipients: a systematic review. European Journal of Cardiovascular Nursing 2014; 13: 108-15.
  55. Conway A, Sheridan J, Maddicks-Law J, Fulbrook P. Pilot testing a model of psychological care for heart transplant recipients. BMC Nursing 2016; 15:62.
  56. Rivka Galchen R. The Medical Miracle of a Pig’s Heart in a Human Body, The New Yorker, -- miracle-of-a-pigs-heart-transplant-in-a-human-body.

Valentina Martinelli, Amanda Magliano, Serena Scalmati, Pierluigi Politi, La consulenza psichiatrica nel trapianto di cuore in "RIVISTA SPERIMENTALE DI FRENIATRIA" 2/2022, pp 41-59, DOI: