Mental health and transplantation in cystic fibrosis

Background: People with cystic fibrosis (PWCF) and their caregivers may face the prospect of lung or liver transplantation as cystic fibrosis (CF) progresses. Despite the links between psychological distress, poor adherence and survival outcomes, their mental health needs may not be consistently addressed. Methods: We conducted a narrative review of mental health aspects of transplantation in PWCF, including health-related quality of life (HRQoL), pre-transplant psychosocial evaluation, neuropsychiatric complications, and psychosocial and psychopharmacologic interventions. Results: Depression, anxiety and post-traumatic stress are common in this population, along with neuropsychiatric complications including cognitive impairment, delirium, side effects of immunosuppression, and drug-drug interactions. CF-specific guidelines recommend routine screening for depression, anxiety, and unmet palliative care needs for PWCF throughout the lifespan. Peri-transplantation, systematic monitoring can modify risk factors for and identify and treat delirium. Guidelines recommend screening, evaluation, and referral to care for depression, anxiety, and PTSD within 6 months post-transplant for PWCF and caregivers. Mental health intervention studies indicate there is potential to improve depression, anxiety, HRQoL, and medical outcomes. Conclusions: As CF progresses, patients and caregivers require preparation for the psychosocial aspects of transplant evaluation, including the salience of social support, treatment adherence, and the importance of early interventions for mental health and substance use disorders. Specialists in mental health, palliative care, and pain management can be enlisted to improve symptoms and functioning in PWCF and caregivers at all stages of the transplant process. Psychological and psychopharmacologic interventions may require adaptation to target the specific needs of PWCF with advanced disease.