Importance of psychiatric evaluation and long-term outcomes of delirium in lung transplant recipients

OBJECTIVE: Lung transplantation (LT) is the only definitive treatment for end-stage lung diseases; however, patients often experience psychiatric problems that can affect post-transplant recovery. Although postoperative delirium frequently occurs, its risk factors and influence on mortality are not well established. This study aimed to evaluate the incidence of LT-associated psychiatric issues and analyse the association of delirium with mortality. DESIGN: Retrospective cohort study. SUBJECTS/PATIENTS: Patients who underwent LT between January 2013 and March 2023. METHODS: We reviewed the incidence of psychiatric conditions before and after LT. Logistic regression analysis identified risk factors for postoperative delirium, and survival analysis was conducted. RESULTS: Pre-transplant psychiatric assessments revealed mild anxiety and depression among 398 patients. Notably, 45% of patients experienced delirium after LT. Patients with a higher body mass index (BMI), longer operation duration and high Beck Anxiety Inventory scores exhibited an increased risk of postoperative delirium. Furthermore, patients who developed postoperative delirium had a higher 2- and 5-year mortality rate. CONCLUSIONS: The findings revealed that pre-transplant anxiety, high BMI and prolonged operative duration increase the risk of postoperative delirium risk, which in turn affects long-term mortality. Comprehensive psychiatric evaluation and targeted management are essential for improving post-transplant outcomes.