The psychosocial correlates of transplant survival.
BACKGROUND
due to the shortage of organs, half of the patients on the waiting list for transplantations die. Clinicians have a duty to identify those patients whom might benefit most. The correlation between psychosocial factors and survival in children who have received lung transplantation for CF has not been investigated.


OBJECTIVE
to examine: (1) differences in physical, demographic and psychological factors between two groups of children with CF, those who did or did not survive the waiting period for transplantation. (2) Correlations between these factors pre-transplantation and length of survival post transplantation.


METHODS
81 children--mean age 11 years 6 months--and their parents underwent semi-structured standardised interviews and completed standardised instruments prior to being placed on the transplantation waiting list. The following domains were measured: child's disability, psychiatric status and self-esteem; quality of marital relationship and parental psychiatric status; and family attitudes and functioning.


RESULTS
20% of the children on the waiting list had a psychiatric disorder and 60% of the parents scored within the psychiatric disorder range. One third of the parents had marital difficulties, and 20% of the families showed chaotic functioning. Only half of the children survived to receive transplantation. Survivors and non-survivors were comparable with regard to all psychological measures. A follow up of the transplanted children, ranging from 3 to 156 months post-transplantation, produced a group of nine survivors and 30 non-survivors. Only two pre-transplant factors showed a significant association with length of survival after transplantation. Severe physical disability was associated with longer survival (P=0.01), and parental hostility to partner was associated with a shortened life span (P=0.04). No other factors were significantly associated with length of survival.


CONCLUSIONS
there is no evidence to suggest that adverse psychosocial factors should be used as a contraindication to transplantation.
Great Ormond Street Hospital, Heart-Lung Transplant Unit, London WC1N 3HJ, UK. Ikkose@gosh.nhs.uk
Esther
E
Serrano-Ikkos
Bryan
B
Lask
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000401:mortality / Q000523:psychology* / Q000601:surgery*; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D011584:Psychology