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Review
. 2025 Nov:248:108407.
doi: 10.1016/j.rmed.2025.108407. Epub 2025 Oct 9.

Mental health and transplantation in cystic fibrosis

Anna M Georgiopoulos  1 , Beth A Smith  2 , Elisabeth P Dellon  3 , Denis Hadjiliadis  4 , Rebecca Colman  5 , Tara M D Mullen  1 , Alexandra L Quittner  6 , Yelizaveta I Sher  7
Affiliations
Review

Mental health and transplantation in cystic fibrosis

Anna M Georgiopoulos et al. Respir Med. 2025 Nov.

Abstract

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.

Keywords: Cystic fibrosis; Liver transplant; Lung transplant; Mental health; Quality of life; Transplantation.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Anna M. Georgiopoulos reports personal fees from the Belgian Cystic Fibrosis Foundation/King Baudouin Foundation; grants, personal fees and travel reimbursement from the Cystic Fibrosis Foundation; grants from the Dutch Cystic Fibrosis Foundation; travel reimbursement from the European Cystic Fibrosis Society; travel reimbursement from the French Cystic Fibrosis Society; personal fees from the Italian Cystic Fibrosis Research Foundation; grant funding from the National Heart, Lung and Blood Institute; grants and personal fees from Vertex Pharmaceuticals; personal fees from University of Kansas Medical Center; and personal fees from Virginia Commonwealth University. Beth A. Smith reports financial support from the Cystic Fibrosis Foundation. Elisabeth P. Dellon reports grant funding and salary support from the Cystic Fibrosis Foundation. Denis Hadjiliadis reports financial support from the Cystic Fibrosis Foundation (for research and as part of center grant) and the NIH (research); none related to current manuscript. Rebecca Colman reports a speaker's honorarium from Boehringer Ingelheim. Alexandra L. Quittner reports financial support from the Cystic Fibrosis Foundation, Vertex Pharmaceuticals, and IQVIA. Yelizaveta I. Sher reports financial support from the Cystic Fibrosis Foundation. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.