Abstract
Objectives: It has been recommended that all candidates for lung transplantation undergo pre-transplant psychosocial evaluation for risk assessment. However, psychosocial issues are only important if they correlate with outcomes after transplantation.Methods: In this prospective study patients who were referred for lung transplantation from 2016 to 2018 (n = 352) at Hannover Medical School were evaluated using the Transplant Evaluation Rating Scale (TERS). Clinical outcomes included listing, and post-transplant outcomes including mortality, medical aspects such as lung allograft dysfunction, hospitalizations, and renal function, behavioral aspects such as BMI and adherence, and mental issues such as levels of depression, anxiety, and quality of life. TERS scores were divided into tertiles and, in addition, the impact of the two subscale scores—“defiance” and “emotional sensitivity”—was investigated.Results: Of the patients who were transplanted (n = 271) and were still alive (n = 251), 240 had already reached their 1-year assessment at the end of 2020 and were evaluated 1 year after the operation. A subgroup of 143 received an extended mental assessment. BMI, adherence scores, levels of anxiety, depression, and quality of life 1 year post-transplantation differed significantly between TERS tertiles with higher TERS scores predicting less favorable outcomes. The TERS subscale “defiance” was predictive of BMI and adherence whereas the TERS subscale “emotional sensitivity” was predictive of symptoms of anxiety and depression, and quality of life 1 year after transplantation. Patients in the lowest TERS tertile were more likely to having been listed and—as a trend—to having survived the first year after transplantationConclusions: Our findings show that psychosocial factors as measured by TERS score are predictors of behavioral and mental outcomes 1 year after lung transplantation. The TERS allows us to focus on psychosocial risk factors that can be treated or minimized before or after transplantation.
Highlights
Lung transplantation is an accepted treatment option for patients with irreversible chronic lung disease, with more than 4,500 procedures performed per year worldwide and 350 in Germany [1, 2]
One study did not find a predictive value of the Psychosocial Assessment of Candidates for Transplant (PACT) on 1-year survival [9] while a more recent study found a significant predictive value of this instrument on longer-term (12 year) survival in lung transplant recipients [10]
In previous studies of our group in patients prior to lung transplantation, we evaluated the level of psychosocial functioning using the Transplant Evaluation Rating Scale (TERS) and validated the TERS and its subscales in patients awaiting lung transplantation [21]
Summary
Lung transplantation is an accepted treatment option for patients with irreversible chronic lung disease, with more than 4,500 procedures performed per year worldwide and 350 in Germany [1, 2]. The objective of pre-surgical psychosocial evaluations is to identify patients at risk for medical, behavioral and emotional complications during and after organ transplantation. This evaluation is supposed to judge suitability for transplantation and to guide proactive interventions before and after transplantation [8]. Others found an association between specific pre-transplant psychosocial factors (executive functioning, memory performance, quality of wellbeing) and mortality following lung transplantation [11, 12]. These studies did not use a structured psychosocial risk scale that accounts for all psychosocial factors
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