Cardiac Transplantation and Psychopathology

Heart transplantation (HT) is a well-established procedure for terminal cardiac disease and is considered the treatment of choice in cases of severe cardiac insufficiency refractory to medical or surgical treatment. Although cardiac transplantation leads to a dramatic improvement in functional status and quality of life, it still represents one of the more invasive and psychologically threatening surgical interventions. HT raises unique psychological issues which originate from the complexity of the entire clinical and therapeutic trajectory as well as from extraordinary symbolicity of the heart and the human source of the graft. Psychiatric and psychological disturbances, mainly mood and anxiety disorders, are common both in the pre- and posttransplant phase, with prevalence rates of 50% in HT candidates and 20–30% in HT recipients, even in the long term. Correct detection and treatment of these conditions is mandatory given their recognized impact on HT main outcomes, including survival. Available interventions include pharmacological treatment, mainly selective serotonin reuptake inhibitors (SSRIs), and psychotherapeutic approaches, but the evidence to guide clinicians’ management of psychopathology in this population is still limited. Further research is needed to optimize treatment and management of psychological outcomes.