Survival effects of neurological and psychiatric co-medications in Liver Transplant patients

Background: Liver transplantation (LT) is the only curative option in patients with end-stage liver disease. Due to significant development in the field, most post-transplant morbidity and mortality are increasingly associated with factors other than the transplantation itself. However, liver transplantation has been more frequently associated with neurological disorders when compared to other solid organ transplants, and higher rates of psychiatric disorders are reported among cirrhotic patients. Therefore, we aimed to assess the neurological and psychiatric co-medications in post-liver transplant patients and their impact on overall survival.

Methods: We investigated the impact of using neurological and psychiatric co-medications on the survival of 3,075 post-liver transplant patients from two cohorts from the USA (n=3013) and South Korea (n=62) between 2000 and 2020.

Results: In the US cohort, co-medication with citalopram (p=0.007), haloperidol (p=0.000), zolpidem (p=0.045), valproate (p=0.000), and Lorazepam (p=0.000) were associated with poorer overall survival. In the Korean cohort, both Lorazepam and Haloperidol were associated with decreased survival, but patient numbers were too low to reach statistical significance. Of note, zolpidem (p=0.006, low numbers) was associated with improved survival in the Korean cohort.

Conclusion: In our large cohort of real-world data post-liver transplant patients, we demonstrated an association between poorer survival and certain neuropsychiatric medications. As these disorders are prevalent in the liver-transplanted population, tailored mental health management approaches are essential, and the use of the respective drugs must be carefully considered as they may influence overall survival.

Publication History

Article published online:
28 August 2023