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Byeon H. Synthesizing the risk of postoperative delirium in organ transplantation. World J Psychiatry 2025; 15(11): 113121 [PMID: 41281535 DOI: 10.5498/wjp.v15.i11.113121]
World J Psychiatry. Nov 19, 2025; 15(11): 113121 Published online Nov 19, 2025. doi: 10.5498/wjp.v15.i11.113121
Synthesizing the risk of postoperative delirium in organ transplantation
Haewon Byeon
Haewon Byeon, Worker's Care and Digital Health Laboratory, Department of Future Technology, Korea University of Technology and Education, Cheonan 31253, South Korea
Author contributions: Byeon H designed the study, was responsible for data interpretation and writing the article.
Supported by National Research Foundation of Korea, No. RS-2023-00237287.
Conflict-of-interest statement: The author declares no conflict of interest in publishing the manuscript.
Corresponding author: Haewon Byeon, PhD, Associate Professor, Director, Worker's Care and Digital Health Laboratory, Department of Future Technology, Korea University of Technology and Education, 1600 Chungjeol-ro, Cheonan 31253, South Korea. bhwpuma@naver.com
Received: August 15, 2025 Revised: September 8, 2025 Accepted: October 11, 2025 Published online: November 19, 2025 Processing time: 80 Days and 23.3 Hours
Abstract
This letter provides a critical appraisal of the comprehensive meta-analysis by Hou et al, which synthesizes the incidence and risk factors for postoperative delirium (POD) in organ transplant recipients. Their work establishes a pooled POD incidence of 20%, with significant variability across organ types (lung 34%, liver 22%, kidney 6%), and identifies key risk factors including primary graft dysfunction, hepatic encephalopathy, and high model for end-stage liver disease/acute physiology and chronic health evaluation II scores. This commentary acknowledges the study's strength in providing a robust, trans-organ synthesis of current evidence. However, it critically discusses the substantial heterogeneity, the counterintuitive non-significance of age as a risk factor, and the unavoidable limitation of unmeasured confounders inherent in meta-analyses, such as preoperative cognitive/psychiatric status and anesthetic protocols. While the findings provide an essential evidence base for risk stratification and prevention, this letter argues that the high heterogeneity underscores the need for organ-specific analysis and calls for large-scale, prospective studies with standardized protocols to translate these findings into reliable clinical prediction tools and targeted interventions.
Core Tip: The meta-analysis by Hou et al provides a crucial summary, establishing a 20% overall incidence of postoperative delirium in organ transplant patients, with rates varying significantly by organ. Key risk factors identified, such as primary graft dysfunction and high model for end-stage liver disease/acute physiology and chronic health evaluation II scores, offer actionable targets for clinical prevention. However, the study's substantial heterogeneity and the unexpected non-significance of age as a risk factor highlight the limitations of pooling diverse studies. This commentary emphasizes that while the meta-analysis is a valuable evidence synthesis, its findings should be interpreted with caution, paving the way for future prospective, organ-specific research with standardized protocols to develop robust clinical tools.
