Unfavorable outcome of heart transplantation in recipients with type D personality.

BACKGROUND The role of personality in heart transplantation (HTx) remains largely unknown. We examined the distressed personality (Type D) as a predictor of outcomes in patients suffering from end-stage heart disease who underwent HTx. METHODS Using the DS14 scale, 51 patients (75% men; 54.1 +/- 9.7 years of age) were diagnosed as Type D or non-Type D in the pre-transplant period. End-points of this prospective follow-up study (mean 5.4 years) were mortality and allograft rejection (Grade > or =3A rejection, rejection-free days after HTx). RESULTS At baseline, 15 patients were diagnosed as Type D and 36 as non-Type D; they did not differ in recipient or donor characteristics. At follow-up, there were 8 deaths; the mortality rate of Type D recipients was 33% vs 8% for non-Type Ds (p = 0.036). Two deaths were due to early post-operative complications and were excluded from further analyses. Type D recipients had a 10-fold higher mortality rate after hospital discharge (5 of 15, or 33%) as compared with non-Type D recipients (1 of 34, or 3%) (p = 0.013, adjusting for age and gender). Among surviving recipients, the rate of Grade > or =3A rejection for both groups was 40% vs 27%, respectively (p = 0.45). The first episode of rejection was diagnosed, on average, after 14 days in Type D recipients vs after 50 days in the other patients (p = 0.032). The risk of unfavorable outcomes (death, Grade > or =3A rejection, or number rejection-free days < or =14) was greater in Type D recipients (12 of 15, or 80%) than in non-Type Ds (13 of 34, or 38%), adjusting for other risk factors (odds ratio: 6.75; 95% confidence interval: 1.47 to 30.97) (p = 0.014). CONCLUSIONS Type D personality independently predicted mortality and early allograft rejection, and should be accounted for when planning interventions to achieve optimal outcomes after HTx.