title: The Psychosocial Assessment of Candidates for Transplantation: A Cohort Study of its Association With Survival Among Lung Transplant Recipients.
abstract: The United Network for Organ Sharing mandates a psychosocial assessment of transplant candidates before listing. A quantified measure for determining transplant candidacy is the Psychosocial Assessment of Candidates for Transplant (PACT) scale. This instrument's predictive value for survival has not been rigorously evaluated among lung transplantation recipients.
  
  
  
  We reviewed medical records of all patients who underwent lung transplantation at Mayo Clinic, Rochester from 2000-2012. A transplant psychiatrist had assessed lung transplant candidates for psychosocial risk with the PACT scale. Recipients were divided into high- and low psychosocial risk cohorts using a PACT score cutoff of 2. The main outcome variable was posttransplant survival. Mortality was analyzed using the Kaplan-Meier estimator and Cox proportional hazard models.
  
  
  
  This study included 110 lung recipients: 57 (51.8%) were females, 101 (91.8%) Whites, mean age: 56.4 years. Further, 7 (6.4%) recipients received an initial PACT score <2 (poor or borderline candidates) and later achieved a higher score, allowing transplant listing; 103 (93.6%) received initial scores ≥2 (acceptable, good or great candidates). An initial PACT score < 2 was modestly associated with higher mortality (adjusted hazard ratio = 2.73, p = 0.04).
  
  
  
  Lung transplant recipients who initially received a low score on the PACT scale, reflecting poor or borderline psychosocial candidacy, experienced greater likelihood of mortality. This primary finding suggests that the psychosocial assessment, as measured by the PACT scale, may provide additional mortality risk stratification for lung transplant candidates.
authors: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN; Psychiatry and Mental Health Service, Sotero Del Rio Hospital, Puente Alto, Santiago, Chile.
authors: Mario J
authors: MJ
authors: Hitschfeld
authors: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN; William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN. Electronic address: schneekloth.terry@mayo.edu.
authors: Terry D
authors: TD
authors: Schneekloth
authors: Psychiatry and Mental Health Service, Sotero Del Rio Hospital, Puente Alto, Santiago, Chile; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
authors: Cassie C
authors: CC
authors: Kennedy
authors: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL.
authors: Teresa A
authors: TA
authors: Rummans
authors: Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL.
authors: Shehzad K
authors: SK
authors: Niazi
authors: Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL.
authors: Adriana R
authors: AR
authors: Vasquez
authors: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors: Jennifer R
authors: JR
authors: Geske
authors: Psychiatry and Mental Health Service, Sotero Del Rio Hospital, Puente Alto, Santiago, Chile; Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors: Tanya M
authors: TM
authors: Petterson
authors: Psychiatry and Mental Health Service, Sotero Del Rio Hospital, Puente Alto, Santiago, Chile; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
authors: Walter K
authors: WK
authors: Kremers
authors: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN; William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN.
authors: Sheila G
authors: SG
authors: Jowsey-Gregoire
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D016013:Likelihood Functions; D016040:Lung Transplantation / Q000401:mortality* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D018579:Patient Selection; D011584:Psychology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000706:statistics & numerical data*; D016019:Survival Analysis
keywords: lung; mortality; risk assessment.; survival; transplantation