Pretransplant predictors of posttransplant adherence and clinical outcome: an evidence base for pretransplant psychosocial screening.
BACKGROUND
There is growing awareness, yet scant prospective evidence that pretransplant (TX) psychosocial factors may predict post-TX outcome. We examined which pre-TX psychosocial factors predict post-TX nonadherence with immunosuppression (NA) and clinical outcomes in heart, liver, and lung TX.


METHODS
We prospectively followed 141 patients (28 heart, 61 liver, and 52 lung) from pre-TX until 1 year post-TX. Multivariable analyses determined which pre-TX factors (i.e., anxiety, depression, personality traits, social support, adherence with medication, and smoking status) predict poor post-TX outcome (i.e., NA, late acute rejection, graft loss, and resource utilization), controlling for medical predictors of poor outcome.


RESULTS
Pre-TX self-reported medication nonadherence (odds ratio [OR]=7.9), lower received social support (OR=0.9), a higher education (OR=2.7), and lower "conscientiousness" (OR=0.8) were independent predictors of post-TX NA. Not living in a stable relationship predicted graft loss (OR=4.9). Pre-TX medication NA was the only predictor for presence of late acute rejection (OR=4.4). No other pre-TX predictors for poor outcome could be found.


CONCLUSIONS
This is the first prospective study demonstrating that selected pre-TX psychosocial factors predict post-TX NA and poor clinical outcome, implying that pre-TX screening should include this set of factors in addition to traditional medical criteria.
Dobbels
Fabienne
F
Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium. fabienne.dobbels@med.kuleuven.be
Vanhaecke
Johan
J
Dupont
Lieven
L
Nevens
Frederik
F
Verleden
Geert
G
Pirenne
Jacques
J
De Geest
Sabina
S
D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D006084:Graft Rejection / Q000523:psychology; D016027:Heart Transplantation / Q000523:psychology; D006801:Humans; D007398:Interpersonal Relations; D016031:Liver Transplantation / Q000523:psychology; D016040:Lung Transplantation / Q000523:psychology; D008297:Male; D008403:Mass Screening; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance; D018579:Patient Selection; D010551:Personality; D010555:Personality Inventory; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000523:psychology; D011446:Prospective Studies; D011584:Psychology; D012086:Reoperation / Q000706:statistics & numerical data; D014180:Transplantation / Q000523:psychology*; D016896:Treatment Outcome