title: The longitudinal impact of psychological functioning, medical severity, and family functioning in pediatric heart transplantation.
abstract: BACKGROUND
  Few data are available on the longitudinal psychological functioning of patients after pediatric heart transplantation. The objective of this study was to determine whether pre-transplant psychological functioning, post-transplant medical severity, and family functioning relate to the psychological functioning of pediatric patients after heart transplantation.
  
  
  METHODS
  The study included 23 patients who underwent heart transplantation between ages 3 and 20 years, survived at least 1 year after transplantation, and had been assessed previously after transplantation between 1993 and 1995. This study reports a second post-transplant assessment between 1999 and 2000. We assessed psychological functioning using the Children's Global Assessment Scale before and after heart transplantation. We assessed medical severity using the number of outpatient visits, hospitalizations, and biopsies and using the Side Effect Severity Scale. We used the Global Assessment of Family Relational Functioning Scale to rate family functioning.
  
  
  RESULTS
  The majority of patients (15/23) were alive at the second follow-up. They had survived a median of 9.6 (6.1-12.9) years after transplantation. Similar to their first follow-up assessments, 73% demonstrated good psychological functioning after heart transplantation. Although we found no correlation between medical severity and post-transplant psychological functioning, we did find a significant correlation between family functioning during the first 2 years of transplantation and post-transplant emotional adjustment.
  
  
  CONCLUSIONS
  The majority of children and adolescents have the capacity for healthy psychological functioning after heart transplantation. Nevertheless, ongoing psychological assessment and intervention is necessary for patients and their families who face pediatric heart transplantation because >25% probably will have emotional adjustment difficulties.
authors.affiliation: Department of Psychiatry, Children's Hospital Boston, Boston, Massachusetts 02115, USA. david.demaso@tch.harvard.edu
authors.forename: David Ray
authors.initials: DR
authors.lastname: DeMaso
authors.forename: Susan
authors.initials: S
authors.lastname: Douglas Kelley
authors.forename: Heather
authors.initials: H
authors.lastname: Bastardi
authors.forename: Patricia
authors.initials: P
authors.lastname: O'Brien
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Blume
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005195:Family Relations; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D011183:Postoperative Complications / Q000523:psychology; D011788:Quality of Life / Q000523:psychology; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D017741:Survivors / Q000523:psychology*