Assessment Of Transplant Candidates Research Articles

Disparities in access to hematopoietic cell transplant persist at a transplant center

Disparities in access to hematopoietic cell transplant (HCT) are well established. Prior studies have identified barriers, such as referral and travel to an HCT center, that occur before consultation. Whether differences in access persist after evaluation at an HCT center remains unknown. The psychosocial assessment for transplant eligibility may impede access to transplant after evaluation. We performed a single-center retrospective review of 1102 patients who underwent HCT consultation. We examined the association between race/ethnicity (defined as Hispanic, non-Hispanic Black, non-Hispanic White, and Other) and socioeconomic status (defined by zip code median household income quartiles and insurance type) with receipt of HCT and Psychosocial Assessment of Candidates for Transplantation (PACT) scores. Race/ethnicity was associated with receipt of HCT (p = 0.02) with non-Hispanic Whites comprising a higher percentage of HCT recipients than non-recipients. Those living in higher income quartiles and non-publicly insured were more likely to receive HCT (p = 0.02 and p < 0.001, respectively). PACT scores were strongly associated with income quartiles (p < 0.001) but not race/ethnicity or insurance type. Race/ethnicity and socioeconomic status impact receipt of HCT among patients evaluated at an HCT center. Further investigation as to whether the psychosocial eligibility evaluation limits access to HCT in vulnerable populations is warranted.

Turkish Validity and Reliability Study of the Scale of Psychosocial Assessment of Candidates for Transplantation (PACT)

The Psychosocial Assessment of Candidates for Transplantation (PACT) scale shows a statistically acceptable level of reliability and validity and can guide clinicians in managing transplant candidates. This study aims to adapt PACT scale to Turkish and evaluate its validity and reliability for Turkish transplant candidates. This was a psychometric study of a sample of 162 patients in the organ transplant services of 2 hospitals in Turkey. The number of patients enrolled in the study was 20 times the number of items on the scale. The research data were collected using PACT. Descriptive statistics, Cronbach's alpha reliability coefficient, Pearson correlation, and factor analysis were used to evaluate the data. The data were analyzed using varimax rotation in principal component analysis. The factor loadings of the items ranged from 0.56 to 0.79. The internal reliability coefficient of the scale is 0.87. It was also found that the scale accounted for the 52.82% of the total variance. According to the results of this study, evidence of the validity and reliability of the PACT was obtained.

Psychosocial assessment of candidates for hematopoietic cell transplantation: A national survey of centers' practices.

This study characterizes pre-hematopoietic cell transplant psychosocial assessment practices with adult patients at centers in the U.S. An online, cross-sectional survey was conducted to describe the content and process of assessment including the high risk factors that influence transplant eligibility and how eligibility decisions are made. Psychosocial professionals (one per center) were invited to participate by sharing their center's practice. The questionnaire was developed by the researchers and pre-tested with a group of hematopoietic cell transplantation social workers. Univariate statistics were used to describe the sample as well as the content and process of psychosocial assessment. Content analysis was conducted on textual data. A total of 90 centers had one psychosocial professional that responded. There was general consistency among centers about the major psychosocial components that are assessed, but variation occurred regarding what, if any, standardized measures were used. Approximately half of centers that used standardized measures used the Psychosocial Assessment of Candidates for Transplantation, Transplant Evaluation Rating Scale, or Stanford Integrated Psychosocial Assessment for transplantation to rate overall psychosocial risk. Most respondents (86%) reported that their center has declined an otherwise medically eligible patient due to psychosocial risk factors. Risk factors most frequently reported as potentially influencing eligibility included no caregiver/poor support system, illicit drug use, and serious, untreated mental illness. Study findings provide a fuller understanding of psychosocial assessment practices, including the challenging ethical issue of psychosocial eligibility, and will help inform best practices.

The Effect of Pre-Transplant Psychosocial Problems on Kidney Transplantation Outcomes

Introduction: The present study aimed to evaluate the association between the pre-transplant psychosocial profile and kidney transplant candidates' clinical outcomes.Methods: The present study population included all patients assessed for kidney transplant candidacy in Sina Hospital, Tehran University of Medical Sciences. The 42 patients who were candidates for kidney transplantation were enrolled in the present study. The mental health was measured by psychosocial assessment of candidates for transplantation (PACT) questionnaire. A global score of equal or lower than 2 was categorized as a low PACT score and equal and higher than 3 was defined as a high score. PACT questionnaire was completed before the kidney transplantation for each patient. The outcomes of our study were post-transplant dialysis, time of dialysis, hospital stay after transplant, rejection after transplant, time of rejection after transplant, delayed graft function, re-hospitalization after transplant, and time of re-hospitalization that were followed after transplantation. Results: A total of 42 patients underwent kidney transplantation; 15 ( 35.7%) patients had a poor PACT score while 27 (64.3%) patients had a high PACT score. There were no significant differences in age, sex, marital status, literacy, insurance, supplementary insurance, smoking, being head of household between the two groups. There were no significant differences between the two groups in clinical characteristics after kidney transplantation (P-value > 0.05). Conclusions: In our study, there was no significant association between psychosocial status and clinical outcomes and it has been suggested that more studies are needed in this field

Evaluation of Transplant Candidates With a History of Nonadherence: An Opinion Piece.

The transparency and validity of assessing the candidacy of a patient for a solid organ transplant have recently been called into question by the media.1 Transplant centers perform a lengthy medical, surgical, and psychosocial evaluation on candidates with organ failure. This process ensures that there are no contraindications to surgery and to the use of long-term immunosuppressive medications. In addition, it helps ascertain if transplant candidates are likely to benefit from the transplant surgery over long term. Pretransplant nonadherence to prescribed therapy, medications, investigations, and clinical visits, is recognized as a relative or an absolute contraindication by transplant programs. For example, the Canadian Society of Transplantation states, given the use of immunosuppressive agents with a narrow therapeutic window, the impact of nonadherence to therapy on the risk of acute rejection and premature graft loss, and the scarcity of donor organs, nonadherence is a contraindication to kidney transplantation.2 This echoes the recommendations of some of the other major transplantation societies as summarized in Table 1.2-8 Most recommend delaying transplant surgery until patients have demonstrated adherence to therapy for 6 months. Table 1. Current Guidelines in the Assessment of Transplant Candidates With a History of Nonadherence.

Pre-Transplant Psychosocial Assessment Practices: A National Survey of Transplant Centers

Background Hematopoietic cell transplant (HCT) is psychologically and socially demanding of patients. As such, they typically undergo psychosocial assessment pre-HCT to identify high risk factors that require intervention before, or close monitoring throughout transplant. Despite consensus that the assessment is a valuable component of the pre-HCT evaluation, there is a lack of evidence-based guidelines for it. This has led to practice variation among centers and fragmented psychosocial data that limit research. The objective of this study was to describe the content (what is assessed) and the process (who is assessed, by whom, when, and how) of the pre-HCT psychosocial assessment at U.S. transplant centers. Methods A survey was conducted with professionals who conduct pre-HCT psychosocial assessments with adult patients. The researchers developed and pre-tested a 22-item questionnaire with input from social workers. The questionnaire included transplant center characteristics, assessment items including standardized measures, and procedural aspects i.e. how high risk factors are handled. Results Of 139 eligible transplant centers, 92 (66%) had a psychosocial professional respond. The number of autologous transplants performed annually ranged from 15-300 and the number of allogeneic transplants ranged from 5-247. Approximately 81% of the centers reported having 1-2 psychosocial professionals who conduct assessments, while the remainder reported having 3-13. These professionals included licensed social workers with a master's degree (78% of centers), psychologists (21%), and psychiatrists (2%). The majority of centers (86%) reported that all patients undergo pre-HCT psychosocial assessment. Of the 3 psychosocial risk rating scales most commonly applied to HCT candidates, the Stanford Integrated Psychosocial Assessment for Transplantation was used most frequently (10 centers), followed by the Psychosocial Assessment of Candidates for Transplantation (5), and Transplant Evaluation Rating Scale (4). Of the many psychometric measures reported, the Patient Health Questionnaire-9 was used most frequently (20 centers). The majority (63%) reported that the assessment is considered most or all of the time when determining HCT eligibility. The majority (86%) also reported that patients have been declined for HCT based on psychosocial reasons such as active substance use, untreated mental illness, and no caregiver. Conclusion Pre-HCT psychosocial assessment practice varies among centers, particularly in standardized and psychometric measures used. Study results are being used to inform the development of an evidence-based assessment tool that would produce standardized, high-quality psychosocial data. The finding that one-third reported the assessment was not considered most of the time in determining HCT eligibility needs to be further studied.

Psychosocial Evaluation of Candidates for Heart Transplant and Ventricular Assist Devices: Beyond the Current Consensus.

Advanced heart failure therapies, including heart transplantation and durable mechanical circulatory support, are available to a limited number of patients because of the scarcity of donors, expense, and large burden of care. The importance of psychological and social determinants of health, including cognitive status, health literacy, psychopathology, social support, medical adherence, and substance abuse, are emphasized in advanced heart failure and further amplified in the context of mechanical circulatory support and heart transplantation. The psychosocial assessment of advanced heart failure therapy candidates remains largely subjective, requiring a multidisciplinary evaluation, which may include psychiatrists, social workers, case managers, financial coordinators, pharmacists, and clinicians. Objective tools-including the Stanford Integrated Psychosocial Assessment for Transplantation, Psychosocial Assessment of Candidates for Transplantation, and Transplant Evaluation Rating Scale-were developed and validated in limited populations to help standardize the evaluation process. Small, retrospective studies have inconsistently shown that these tools may predict clinical outcomes in the transplant population, with higher-risk scores associated with readmissions, rejection episodes, and infections. However, it has been more difficult to show that these tools can predict mortality, and their applicability to the mechanical circulatory support population is less studied. The International Society for Heart and Lung Transplantation released a consensus statement in 2018 to promote consistency of psychosocial evaluation across advanced heart failure programs, but it lacks specific recommendations given the current state of evidence. This state-of-the-art review expands on the current consensus by critically reviewing current studies supporting available objective assessment tools, proposing a psychosocial evaluation framework that uses a multidisciplinary approach and offering future directions for research.

Psychosocial Assessment of Candidates for Transplantation (PACT) Score Identifies High Risk Patients in Pediatric Renal Transplantation.

Background: Currently, there is no standardized approach for determining psychosocial readiness in pediatric transplantation. We examined the utility of the Psychosocial Assessment of Candidates for Transplantation (PACT) to identify pediatric kidney transplant recipients at risk for adverse clinical outcomes.Methods: Kidney transplant patients <21-years-old transplanted at Duke University Medical Center between 2005 and 2015 underwent psychosocial assessment by a social worker with either PACT or unstructured interview, which were used to determine transplant candidacy. PACT assessed candidates on a scale of 0 (poor candidate) to 4 (excellent candidate) in areas of social support, psychological health, lifestyle factors, and understanding. Demographics and clinical outcomes were analyzed by presence or absence of PACT and further characterized by high (≥3) and low (≤2) scores.Results: Of 54 pediatric patients, 25 (46.3%) patients underwent pre-transplant evaluation utilizing PACT, while 29 (53.7%) were not evaluated with PACT. Patients assessed with PACT had a significantly lower percentage of acute rejection (16.0 vs. 55.2%, p = 0.007). After adjusting for HLA mismatch, a pre-transplant PACT score was persistently associated with lower odds of acute rejection (Odds Ratio 0.119, 95% Confidence Interval 0.027–0.52, p = 0.005). In PACT subsection analysis, the lack of family availability (OR 0.08, 95% CI 0.01–0.97, p = 0.047) and risk for psychopathology (OR 0.34, 95% CI 0.13–0.87, p = 0.025) were associated with a low PACT score and post-transplant non-adherence.Conclusions: Our study highlights the importance of standardized psychosocial assessments and the potential use of PACT in risk stratifying pre-transplant candidates.

Psychosocial Evaluation of Candidates for Mechanical Circulatory Support and Risk for Adverse Post-Implantation Medical Outcomes

Purpose A psychosocial evaluation is required for candidates for long-term mechanical circulatory support (MCS). Despite guidelines and recommendations for elements to be included in this evaluation, few data indicate whether evaluation findings are prognostic for adverse outcomes after MCS implantation. We examined this issue with respect to post-implant survival time, rehospitalization, and adverse medical events (AEs). Methods A single-site retrospective analysis was performed using prospectively collected data for all patients aged ≥18 receiving long-term MCS between 4/2004-12/2017. We coded pre-implant psychosocial evaluations with an established rating system (Psychosocial Assessment of Candidates for Transplantation, Modified for MCS; m-PACT). The m-PACT yields a Total score (calculated so that higher=less favorable; range=0-20) and scores for 10 components reflecting social support; mental health and substance use; ability to perform activities of daily living; and knowledge and adherence to current medical requirements. Competing risk models (competing risks: transplant, weaning from MCS) were estimated to determine associations of m-PACT Total and component scores with survival time on MCS, time to unscheduled rehospitalization, and time to any of 14 classes of AEs. Pre-implant demographic and clinical factors were controlled. Results In 238 MCS patients (M±SD age 56±13, 81% male, 83% white, 62% bridge to transplant, median time on MCS=256 days), survival time and time to rehospitalization were not significantly associated with m-PACT Total. However, for each 1-point m-PACT Total score increase, AE risk increased by 7% (hazard ratio, HR=1.07, CI: 1.01, 1.15, p=.028). The individual types of AEs most affected were cardiovascular dysfunction and device malfunctions. The m-PACT components accounting for the influence of m-PACT Total on AE risk were poorer medical adherence at the time of the evaluation (HR=1.74, CI: 1.14, 1.67, p=.001), and mental health problems (HR=1.20, CI: 1.02, 1.61, p=.035). Conclusion The psychosocial evaluation may provide prognostic information for post-implant outcomes. Strategies to address psychosocial risk factors either before implant or as soon as possible post-implant may help to reduce AE risk and thereby promote patient well-being during MCS.

Psychosocial Risk Impacts Mortality in Women After Liver Transplantation

Liver transplant candidates undergo psychosocial assessment as a component of their pretransplant evaluation. Global psychosocial assessment scales, including the Psychosocial Assessment of Candidates for Transplantation (PACT), capture and quantify these psychiatric and social variables. Our primary aim was to assess for an association between global PACT score and survival in liver transplant recipients. This retrospective cohort study examined records of all liver recipients at one U.S. Transplant Center from 2000 to 2012 with outcomes monitoring until 07/01/2016. We investigated for associations between the following variables and mortality: PACT score, age, gender, marital status, race, alcoholic liver disease (ALD), and body mass index (BMI). Statistical methods included Student's t-test, Wilcoxon rank sum test, chi-square, Fisher's exact test, Kaplan-Meier curve, and Cox proportional hazard models. Of 1040 liver recipients, 538 had a documented PACT score. Among these, PACT score was not associated with mortality. In women, a lower PACT score was associated with mortality (p = 0.003) even after adjustments for age, marital status, and BMI. Women with ALD had a 2-fold increased hazard of death (p = 0.012). Increasing age was associated with increased risk of death for the cohort as a whole (p = 0.019) and for men (p = 0.014). In men, being married and BMI were marginally protective (p = 0.10 and p = 0.13, respectively). Transplant psychosocial screening scales, specifically the PACT, identify psychosocial burden and may predict post-transplant outcomes in certain populations. In female liver recipients, lower PACT scores and ALD were associated with a greater risk of post-transplant mortality.

Psychosocial Risk Predicts New Episode Depression After Heart Transplant

Psychosocial assessment is an essential component of the pretransplant evaluation. Many individuals have significant psychosocial problems, and they are either denied for transplantation or deferred from listing and transplant until the psychosocial issues are addressed. The primary aim of this study was to evaluate the outcomes of patients who initially had significant psychosocial problems, but who addressed them and received a heart transplant. This retrospective study included heart transplant recipients from 1/1/2000 to 12/31/2012. Those with initial Psychosocial Assessment of Candidates for Transplantation (PACT) scale score <2 were compared with those whose initial score was ≥2 for the variables new onset depression and anxiety, length of stay, rejection, and survival using logistic and linear regression and Cox proportional hazards modeling. Of 164 heart recipients with pretransplant PACT scores, 46 (28%) were female, 154 (94%) were white, and the mean age was 52.7years. Only 11 (7%) received an initial PACT score <2; these candidates underwent heart transplantation after their scores increased to ≥2. Initial PACT <2 increased the odds of new depression by 11-fold (p = 0.002), but was not associated with differences in survival, posttransplant length of stay, the occurrence of treated episodes of rejection or new anxiety (p ≥ 0.20 for all). Among heart recipients, initially high pretransplant psychosocial risk, as assessed by PACT, was associated with posttransplant new episode depression. However, after addressing the primary psychosocial issues before transplant, posttransplant length of stay, organ rejection, and survival were the same as those without prior psychosocial concerns.

Utility of the Psychosocial Assessment of Candidates for Transplantation in Patients Undergoing Continuous-Flow Left Ventricular Assist Device Implantation.

Psychosocial assessment of patients comprises an important element in the selection process of appropriate candidates for left ventricular assist device (LVAD) implantation. We sought to determine the association of the well-validated psychosocial assessment of candidates for transplantation (PACT) scale to clinical outcomes post-LVAD implantation. The PACT scale was used retrospectively to reconstruct psychosocial profiles of all patients who underwent a continuous-flow LVAD implantation for all indications at our institution between March 2008 and August 2012 (N = 230). Psychosocial elements including social support, psychological health, lifestyle factors, comprehension of the operation, and follow-up were evaluated. The primary outcome was overall survival, and the secondary outcomes were hospital readmission, pump thrombosis, hemolysis, gastrointestinal (GI) bleeding, and LVAD driveline infections. The mean age of patients was 55.3 years, with 83% being male; 58% (N = 135) were bridge to transplant and 42% (N = 95) were destination therapy. Up to 1-year post-LVAD implant, there were no statistical differences among the 5 PACT candidate groups in terms of survival ( P = .79), hospital readmissions ( P = .55), suspected or confirmed pump thrombosis ( P = .31), hemolysis ( P = .43), GI bleeding ( P = .71), or driveline infections ( P = .06). In this single-center retrospective review, post hoc reconstruction of psychosocial profiles using the PACT scale and independent assessment of postimplant outcomes, including survival and adverse events, did not show any association. However, given the small number of patients in the low score PACT groups as well as limited duration of follow-up, further studies are required to elucidate the association.

Liaison psychiatry: heart and lung transplantation

SUMMARYOwing to the continuing shortage of organs, the demand for transplantation outstrips supply. Liaison psychiatrists, as part of a multidisciplinary team, have a key role in the assessment of transplant candidates and participate in the decision-making process regarding ‘listing’ the patient for transplantation. Psychiatric and psychosocial factors affect prognosis post-transplantation and there are absolute and relative contraindications to transplantation. The skills of the liaison psychiatrist are employed throughout the patient's illness journey, in the pre-, peri- and post-transplantation periods.LEARNING OBJECTIVES•Learn the salient factors in a pre-transplantation psychosocial assessment•Know the contraindications to transplantation•Appreciate the factors associated with a poor outcome post-transplantationDECLARATION OF INTERESTNone.

Development of the Japanese Version of the Psychosocial Assessment of Candidates for Transplantation in Allogeneic Hematopoietic Stem Cell Transplantation

The Psychosocial Assessment of Candidates for Transplantation (PACT) is a validated instrument for evaluating psychosocial risk factors in transplant candidates. This study examined reliability and validity of the Japanese version of the PACT (J-PACT). PACT is a clinician-rated scale consisting of an initial rating, 8 subscales, and a final rating. J-PACT was developed through a translation and back-translation procedure. Seventy adult patients who underwent allogeneic hematopoietic stem cell transplant between April 2009 and December 2013 received retrospective J-PACT ratings based on medical records. Interrater reliability and concurrent validity with Hospital Anxiety and Depression Scale (HADS) and Profile of Mood Status (POMS) scores were assessed. Interrater reliability for each J-PACT item was generally high, ranging from 0.53 (drug and alcohol use)-0.93 (support stability). The concurrent validity analyses revealed the following significant relationships (p < 0.05). Higher support stability was associated with lower HADS depression (p = 0.02), POMS anger (p = 0.001), POMS fatigue (p = 0.03), and POMS confusion (p = 0.01) scores. Higher support availability was associated with lower POMS anger scores (p = 0.01). More suitable personality was associated with lower HADS anxiety (p = 0.04) and HADS depression (p = 0.048) scores. Better scores on lifestyle factors and alcohol use were both associated with lower POMS confusion scores (p = 0.01, 0.04, respectively). Better final rating was associated with lower HADS anxiety (p = 0.03) and HADS depression (p = 0.02) scores. J-PACT was reliable and valid, although further study is needed to confirm these findings.

Higher Hematopoietic Cell Transplant Comorbidity Index (HCT-CI) Is Associated with Poor Psychosocial Health Pre-Autologous Stem Cell Transplantation (ASCT) in Lymphoma Patients

The assessment of pre-transplant comorbidities is crucial for risk-stratification and is a tool to guide clinical decisions in hematological malignancy patients (pts) undergoing evaluation for stem cell transplantation (SCT). The HCT-CI scale is commonly used to identify high risk patients pre-transplant as it is highly predictive of non-relapse mortality (NRM), severity of graft versus host disease and survival after allogeneic SCT (Sorror et al, Blood 2005; Sorror et al, Blood 2014). However, its role in ASCT remains undefined. In a Center for International Blood and Marrow Transplant Research analysis, HCT-CI score of ≥3 was prognostic for higher NRM and overall mortality in ASCT patients (Sorror et al, Biol. Blood Marrow Transplant 2015), but other single institution studies have failed to confirm this observation in lymphoma patients (Jaglowski et al, Bone Marrow Transplant 2014; Dahi et al, Biol. Blood Marrow Transplant 2014; Hosing et al, Ann. Oncol. 2008). No study has correlated HCT-CI with psychosocial functioning in the setting of ASCT.We conducted a retrospective study of 350 patients with Hodgkin (N=70) and non-Hodgkin Lymphoma (N=280) who underwent ASCT at our institution from January 2009 to June 2015. Based on their HCT-CI score, patients were categorized into low risk (score 0, N=90), intermediate risk (score 1-2, N=123) and high risk (score ≥3, N=137). Psychosocial Assessment of Candidates for Transplantation (PACT) scale (0-4: 0 being poor candidate for procedure and 4 being excellent candidate) (Foster et al. BMT 2009) was used for pre-transplant psychosocial risk assessment and was available for 235 pts. We analyzed the impact of HCT-CI on transplant outcomes and its correlation with PACT scores.Our cohort was predominantly male (63%), and Caucasian (93%) with a median age of 55 years (range 20-78). The majority of the pts (96%) had good performance status with an ECOG of 0-1. The primary diagnosis was NHL in 80%, with mostly advanced stage disease (80%), and no B symptoms (93%). Median time from diagnosis to ASCT was 16 months with 75% of the pts having received ≤2 prior therapies. The median annual income based on zip code was $49406 (range $18753-127312). Disease status prior to transplant was CR/PR in 93% of the subjects. Patient and disease characteristics were comparable among the 3 HCT-CI risk groups. Higher HCT-CI risk category was associated with a lower median household income (p=0.012), higher LDH (p=0.004), more days of apheresis (p=0.026) and lower CD34+ dose x106/kg (0.046). In relation to PACT scores, higher HCT-CI was associated with poor mental health (p<0.001), decreased coping skills (p<0.001), unhealthy lifestyle habits/sedentary life (p<0.001), decreased compliance with medications/medical advice (p=0.014) and inadequate medical/transplant knowledge (p=0.017) and lower final PACT score (p<0.001). Median follow up was 35 months with 100 observed deaths, of which 72 were attributed to relapse. The 5 year estimated relapse rate, NRM, relapse free survival (RFS) and overall survival (OS) in our cohort were 42%, 11%, 49% and 62% respectively. On univariate analysis, there was no significant difference between high vs. low/intermediate HCT-CI scores on 30 day readmission rates (OR 1.24, p=0.61), 100 day mortality (OR 1.12, p=0.86), incidence of secondary malignancy (HR 0.41, p=0.17), relapse rate (HR 0.92, p=0.64), relapse mortality (HR 1.35, p=0.20), NRM (HR 0.86, p=0.71), OS (HR 1.2, p=0.37) or RFS (HR 0.98, p=0.92). Though not statistically significant, the intermediate risk group was noted to have higher 100 day mortality and NRM compared to the low and high risk groups.To our knowledge, this is first study to correlate pre-transplant HCT-CI with PACT scores in lymphoma pts who underwent ASCT. Higher HCT-CI was associated with lower socioeconomic status, poor mental health and coping skills, unhealthy lifestyle habits, decreased medical/transplant knowledge and compliance. HCT-CI did not predict survival in our cohort. Further studies are needed to investigate the association between psychosocial risk factors and HCT-CI and define their combined utility in pre-transplant risk assessment in ASCT patients. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Psychosocial Assessment of Candidates for Transplantation (PACT) Score as Predictor of New Episode Depression among Heart Transplant Recipients

Psychosocial Assessment of Candidates for Transplantation (PACT) Score as Predictor of New Episode Depression among Heart Transplant Recipients

The Psychosocial Assessment of Candidates for Transplantation: A Cohort Study of its Association With Survival Among Lung Transplant Recipients

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.

Unified Protocol for psychiatric and psychological assessment of candidates for transplantation of organs and tissues, PSI-CAT

IntroductionTransplantation is the treatment option that offers improved survival and quality of life as compared to organ failure. Psychiatric and psychological aspects of transplant candidates are important, especially in the pre-assessment stage, as the influence of these factors can hinder post-surgical outcome in both the implanted organ survival and the quality of life of the transplanted person. Of particular importance, the factors related to pathology are due to substance use, psychopathology, and psychosocial support. There are currently few guidelines on the correct evaluation of patients eligible for these complex procedures. MethodNineteen psychiatrists and clinical psychologists from six public hospitals in Catalonia conducted a systematic consensus to determine the design of a Unified Protocol psychological and psychiatric evaluation. An annual work plan was implemented, during which; the objectives were defined, a literature review was conducted, the inclusion and exclusion criteria were discussed, questionnaires were selected, and a structured interview was developed. ResultsWith the implementation of the work plan, the Assessment Protocol presented in this article was designed. Conclusionssystematic work and improving cooperation between psychiatrists and clinical psychologists, has led to homogeneity and consensus on a unified evaluation protocol.

Association between initial psychosocial assessment of candidates for transplantation (PACT) score and mortality among lung transplant recipients at Mayo Clinic, Rochester

Association between initial psychosocial assessment of candidates for transplantation (PACT) score and mortality among lung transplant recipients at Mayo Clinic, Rochester

PET imaging in liver transplantation for primary hepatocarcinoma

Liver transplantation (LT) is effective for suitable patients with HCC and may be the only curative treatment for those with unresectable HCC. The outcomes of LT for HCC are closely related with the assessment of transplantation candidates, management of patients on the waiting list and postoperative surveillance for HCC recurrence. PET imaging plays a significant role in LT process. The applications of PET imaging in LT for HCC are reviewed in this article. Key words: Liver neoplasms; Liver transplantation; Tomography, emission-computed; Trends