Evaluating Resilience as a Predictor of Outcomes in Lung Transplant Candidates

Abstract

Resilience can be defined as a patient's capacity to adapt to or recover from adverse experiences. We hypothesize that resilience may be an important factor associated with lung transplant outcomes. Our objective was to describe resilience in lung transplant candidates and examine resilience as a potential predictor of lung transplant outcomes. Adult lung transplant candidates on the waiting list between 9/16/2015 to 10/1/2019 at six transplant centers were mailed prospective questionnaires which included the validated Connor-Davidson Resilience Scale (RISC-10). Non-responders were declared non-participators after three recruitment attempts by mail. Demographics and transplant-related outcomes were recorded. Survey metrics were excellent with 56.9% participation (N = 199) and <0.05% missing item responses. Participants had a mean age of 59 (± 9) years. A majority of participants were female (51%), white (93%), and married (71%). Mean pre-transplant RISC-10 score was 32.0 ± 5.6, similar to population norms (32.1 ± 5.8). However, 31 participants (16%) had a RISC-10 score ≥1 SD below population norms (≤ 26.3). Low RISC-10 score participants did not differ from the others by race, sex, age, or primary diagnosis. The average duration of follow-up was 7.7 months. During the study, 110 participants were transplanted, 18 delisted, 22 died while listed, and 49 remained waiting. Post-transplant deaths were limited (N = 18). Of survivors, 88 completed post-transplant surveys (80%). Post-transplant scores increased by 1.4 (95% CI 0.29 to 2.6; p = 0.01) however this is less than the minimum clinically important difference (≥2.9). RISC-10 was not associated with death, delisting or health-related quality of life measures. In single-item analysis, stress-related questions scored lower than other questions. In lung transplant candidates, resilience was comparable to population norms. However, one in six lung transplant candidates had low resilience. Addressing stress may be a potential target for improving resilience in future studies.