2026 Eastern States Conference

Authors: Leah Dykstra, PharmD; Emily Burns, PharmD; Abigail Mathes, PharmD; Mary Roth, PharmD, BCCP, BCPS 
Objective: Audience members will be able to quantify the frequency of changes made to serotonergic medications for depression and anxiety at UVA Health during the listing period due to the potential need for methylene blue to manage vasoplegia.
Background: Depression/anxiety are common in cardiac transplant candidates and many take serotonergic medications. These increase serotonin syndrome risk if methylene blue is used for perioperative vasoplegia, so medications may be changed before transplant.
Methods: This retrospective, observational study included adults who underwent cardiac transplant at UVA Health between January 1, 2014 and July 1, 2025. Patients taking serotonergic medications for depression/anxiety during the listing period were included in the primary analysis. Medications were classified as high or non-high risk based on serotonin syndrome potential if used with methylene blue. The high risk group included patients taking >1 high risk medications, while the non-high risk group included patients taking only non-high risk medications. The primary endpoint was the proportion of patients with medication changes during the listing period. Secondary endpoints included frequency of depression/anxiety, serotonergic medication use within 72 hours pre-transplant, vasoplegia and its management, serotonin syndrome, and post-transplant medication re-initiation. Data were collected via electronic medical record review and analyzed using descriptive statistics and chi-square tests.
Results: Among 111 cardiac transplant patients, 41 were on >1 serotonergic medications for depression/anxiety during the listing period (28 in the high risk group and 13 in the non-high risk group). Medication changes occurred in 23 (79%) patients in the high risk group versus 6 (21%) in the non-high risk group (p=0.029). Within 72 hours of transplant, 12 patients were in the high risk group and 16 in the non-high risk group. Vasoplegia occurred in 5 (42%) high risk group patients (0 received methylene blue) and 5 (31%) non-high risk group patients, of whom 2 (40%) received methylene blue. No cases of serotonin syndrome were documented.
Conclusions: Medication changes prior to cardiac transplant were more frequent in the high risk group than in the non-high risk group, likely to reduce serotonin syndrome risk with potential methylene blue use. However, no high risk group patients received methylene blue or developed serotonin syndrome. These findings suggest pre-transplant serotonergic medication changes may offer limited benefit and risk worsening depression/anxiety, especially at institutions where alternatives to methylene blue are used.
Self-assessment question: Based on UVA practice and the data presented in this project, which of the following would be a reasonable recommendation to make for a patient listed for cardiac transplant who takes sertraline and buspirone for depression/anxiety?