title: Impact of primary caregivers on long-term outcomes after lung transplantation.
abstract: BACKGROUND
  Current guidelines consider the absence of a dependable social support system as an absolute contraindication to lung transplantation, yet there are varying degrees of social support among those selected for transplantation. We sought to characterize the relationship between a patient's self-reported primary caregiver and long-term outcomes after lung transplantation.
  
  
  METHODS
  We conducted a retrospective cohort study of all lung transplant recipients ≥18 years of age who had undergone an initial transplant (2000 to 2010). Cox regression was used to explore the relationship between type of caregiver and the long-term risk of death and chronic graft failure while adjusting for potential confounders.
  
  
  RESULTS
  There were 452 patients undergoing lung transplantation over the study period who met the inclusion criteria. Five types of primary caregivers were identified, with spouse 60% (270 of 452) being the most common. Compared with spousal caregiver, overall survival was significantly worse for patients who identified an adult child (hazard ratio [HR] 2.04, 95% confidence interval [CI] 1.15 to 3.60) or sibling (HR 3.79, 95% CI 2.48 to 5.78) as their primary caregiver. In addition, risk for long-term graft failure was increased significantly (HR 3.34, 95% CI 1.58 to 7.06) among patients with sibling caregivers.
  
  
  CONCLUSIONS
  Type of primary caregiver selected before transplantation was associated with long-term outcomes. These results may be a reflection of the long-term support requirements and/or competing responsibilities of other caregiver types. Interventions to increase support for at-risk patients may include identifying additional caregivers during the pre-transplant assessment. As lung allocation is designed to maximize graft potential, risk stratification for listing patients should include type of caregiver and be considered as critically as major organ dysfunction.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Washington. Electronic address: nathan.mollberg@gmail.com.
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Mollberg
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Washington.
authors.forename: Farhood
authors.initials: F
authors.lastname: Farjah
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Washington.
authors.forename: Eric
authors.initials: E
authors.lastname: Howell
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Washington.
authors.forename: Juan
authors.initials: J
authors.lastname: Ortiz
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Washington.
authors.forename: Leah
authors.initials: L
authors.lastname: Backhus
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Washington.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Mulligan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017028:Caregivers / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014861:Washington / Q000453:epidemiology; D055815:Young Adult
keywords: caregivers; follow-up; lung transplantation; support; survival