S2479 Real-World Incidence of New Onset Mental Health Conditions in Patients Listed for Liver Transplantation

Introduction: Patients listed for liver transplantation often experience significant emotional and psychological stress due to the severity of liver disease and the uncertainty of receiving a transplant. While the physical burden of liver failure is well-studied, there is limited large-scale data on the incidence of mental health disorders following transplant listing. This study aimed to evaluate the real-world incidence of new-onset mental health conditions in liver transplant-listed patients using a large, multicenter federated health database. Methods: We conducted a retrospective cohort analysis using the TriNetX US Collaborative Network, which includes data from 65 healthcare organizations. Adult patients (≥18 years) with a diagnosis indicating liver transplant status (International Classification of Diseases, Tenth Revision: Z94.4) but without a record of liver transplant procedure were included. To isolate new-onset conditions, we excluded all patients with documented diagnoses of depression, anxiety disorders, mood disorders, post-traumatic stress disorder (PTSD), adjustment disorders, eating disorders, ADHD, or self-harm behaviors prior to the listing date. The index event was the first documentation of liver transplant listing, and outcomes were assessed beginning 1 day afterward. The incidence of each mental health outcome was calculated using risk analysis and Kaplan–Meier survival methods. Results: Among 30,711 eligible patients listed for liver transplant with no prior mental health diagnosis, the incidence of new-onset depression was 11.8%. Adjustment disorders occurred in 3.3%, anxiety disorders in 2.2%, mood disorders in 1.0%, PTSD in 0.9%, and panic disorders in 0.8%. Self-harm or suicidal ideation was observed in 0.8%, ADHD in 0.9%, and eating disorders in 0.3%. Kaplan–Meier survival analysis indicated that most mental health diagnoses occurred within 2 years of listing. Conclusion: Mental health disorders are common in patients listed for liver transplantation, with depression affecting nearly 1 in 8 individuals. These findings highlight the urgent need for structured psychological evaluation, early psychiatric support, and ongoing mental health surveillance for patients on the transplant waiting list.