Dr NICOLE DE LA MATA1, Professor ANGELA WEBSTER1,2,3, Dr NICHOLAS CROSS4, Dr HEATHER DUNCKLEY5, Miss RACHEL CUTTING1, Dr BEN BEAGLEHOLE6, Dr IAN DITTMER7, Dr JOHN IRVINE4, Dr CURTIS WALKER8, Ms MERRYN JONES9, Dr MELANIE WYLD1,3, Associate Professor PATRICK KELLY1, Professor KATE WYBURN1,10
1University of Sydney, Camperdown, Australia, 2National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, Australia, 3Westmead Applied Research Centre, Westmead Hospital, Westmead, Australia, 4Department of Nephrology, Canterbury District Health Board, Christchurch Hospital, Christchurch, New Zealand, 5New Zealand Transplantation and Immunogenetics Laboratory, New Zealand Blood Service, Auckland, New Zealand, 6Department of Psychological Medicine, University of Otago, Christchurch, New Zealand, 7Auckland City Hospital, Auckland District Hospital Board, Auckland, New Zealand, 8Internal Medicine, Medical Council of New Zealand, Mid Central District Health Board, Wellington, New Zealand, 9Renal Services, Ballantyne House, Hawke’s Bay District Health Board, New Zealand, 10Renal Unit, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, Australia
Aim: To evaluate the impact mental illness has upon post-transplant outcomes, including graft failure and death, in kidney transplant recipients in New Zealand.
Background: Depression and anxiety affect at least 20% of people with kidney disease and up to 40% of dialysis patients. It is likely disparities exist in post-transplant outcomes for people with mental illness and kidney failure compared to those with kidney failure alone.
Methods: We included all kidney transplant recipients in New Zealand, 2006-2019 from the ASSET linked data platform, including ANZDATA and administrative health databases (i.e., hospitalisations, prescriptions, and mental health services). Mental illness was past use of antidepressants, anxiolytic buspirone or antipsychotics ≥two occasions/year. Follow-up was from first kidney transplant until death, graft failure or last follow-up. We used Cox models to evaluate risk of graft failure or death for those with mental illness compared to without, adjusting for age, sex, calendar year and prior dialysis time.
Results: Mental illness affected 6% of the 1,499 kidney transplant recipients, where 81 had moderate and 15 had severe mental illness. There were 101 graft failures (7%) and 82 deaths (6%) in those without mental illness, compared to 7 graft failures (7%) and 12 deaths (13%) in those with mental illness. After allowing for age, sex, calendar year and prior dialysis time, mental illness was not associated with a higher risk of graft failure (HR:1.20, 95%CI:0.55-2.64, p=0.65), but was associated with twice the risk of death (HR:2.00, 95%CI:1.07-3.75, p=0.03).
Conclusions: People with mental illness have greater risk of death post-transplant, but not graft failure compared to people without mental illness. Transplantation offers an opportunity to engage with mental health services to reduce post-transplant mortality.
Biography:
Dr Nicole De La Mata is an early-career researcher and post-doctoral biostatistician at the Sydney School of Public Health, The University of Sydney. She has extensive experience in using administrative health linked data to undertake health services research in kidney disease and organ transplantation. Her work aims to improve the quality and efficiency of health services to translate into better and more equitable outcomes in people with kidney disease. She specialises in advanced statistical modelling of complex clinical scenarios, with a special interest in multi-state modelling approaches.