Trends and Risk Factors for Suicide in Thoracic Transplantation

INTRODUCTION: Transplant is a complex psychosocial experience, and rates of suicide are increased after abdominal transplant. This study aimed to characterize the suicide rates of heart and lung transplant recipients and to identify risk factors associated with suicide after thoracic transplant. METHODS: We used the United Network for Organ Sharing(UNOS)/Organ Procurement and Transplantation Network(OPTN) database to identify deceased adult (≥ 18 years) recipients of isolated primary heart or lung transplant between 1995 and 2022 and stratified by cause of death of suicide vs. other causes. Multivariable logistic regression was performed to identify factors associated with suicide. RESULTS: From 1995 to 2022, there were 112 deaths by suicide among 46 945 deceased recipients. The overall suicide rate for heart and lung transplant recipients was 109.41 per 100 000. Recipients who died by suicide were more likely to be male (86.6% vs. 65.8%, p < 0.001), white (90.2% vs. 77.6%, p = 0.006), and receive a heart (66.1% vs. 50.2%, p = 0.001). Recipients who died by suicide also had a shorter hospital length of stay (LOS) (13 vs. 16 days, p = 0.003). White recipient race (aOR 3.98, p = 0.008) and male sex (aOR 4.42, p < 0.001) were associated with increased risk of suicide, while increased age, longer LOS, and receipt of a lung versus heart were associated with lower risk of suicide. CONCLUSIONS: Suicide rates among heart and lung transplant recipients exceed national averages. White and male recipients are at the highest risk, while older, lung recipients with longer LOS are at lower risk. To address this, psychiatric care in transplant teams is important, especially for those identified as at high risk of suicide.