Transplant Evaluation Rating Scale Research Articles

Psychosocial assessment tools for use before transplantation are predictive of post-operative psychosocial and health behavior outcomes: a narrative review of the literature.

In end-stage diseases, transplantation may be necessary. The limited number of donors led to the development of several pre-transplant psychosocial assessment tools. We summarized the predictive value of these tools before solid-organ transplantation. The PRISMA search strategy and the MEDLINE database were used to review the literature. From 1,050 records, we found thirteen studies using four different scales (Millon Behavioral Health Inventory [MBHI], Psychosocial Assessment of Transplant Candidates [PACT], Stanford Integrated Psychosocial Assessment for Transplantation [SIPAT], and Transplant Evaluation Rating Scale [TERS]). TERS and MBHI were associated with the highest number of positive studies concerning pre-transplant scores and primary outcomes. Psychosocial scales predict in a systematic way psychosocial and health behavioural outcomes, but generated mixed results for mortality and rejection. This narrative review underlines the need for multidisciplinary evaluation and well-conducted clinical trials to assist transplant teams in utilizing psychosocial evaluation effectively during evaluation of candidates.

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.

Psychosocial Pre-Transplant Screening With the Transplant Evaluation Rating Scale Contributes to Prediction of Survival After Hematopoietic Stem Cell Transplantation.

There is no standard in hematopoietic stem cell transplantations (HSCT) for pre-transplant screening of psychosocial risk factors, e.g., regarding immunosuppressant non-adherence. The aim of this prospective study is to explore the predictive value of the pretransplant psychosocial screening instrument Transplant Evaluation Rating Scale (TERS) for mortality in a 3-year follow-up. Between 2012 and 2017 61 patients were included and classified as low (TERS = 26.5–29) and increased-risk group (TERS = 29.5–79.5). Both groups were compared regarding mortality until 36 months after transplantation and secondary outcomes [Medication Experience Scale for Immunosuppressants (MESI); incidence/grade of GvHD]. The increased-risk group (n = 28) showed significantly worse cumulative survival in the outpatient setting (from 3 months to 3 years after HSCT) [Log Rank (Mantel Cox) P = 0.029] compared to low-risk group (n = 29) but there was no significant result for the interval immediately after HSCT until 3 years afterwards. Pre-transplant screening with TERS contributes to prediction of survival after HSCT. The reason remains unclear, since TERS did not correlate with GvHD or MESI. The negative result regarding the interval immediately after HSCT until 3 years could be caused by the intensive in-patient setting with mortality which is explained rather by biological reasons than by non-adherence.

The Transplant Evaluation Rating Scale Predicts Clinical Outcomes 1 Year After Lung Transplantation: A Prospective Longitudinal Study.

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.

The Transplant Evaluation Rating Scale predicts overall survival after allogeneic hematopoietic stem cell transplantation

AbstractTo evaluate the impact of psychosocial risks on post–hematopoietic stem cell transplantation (HSCT) outcomes, we prospectively conducted psychosocial assessment of 556 consecutive allogeneic HSCT patients who received their first allogeneic transplant at our center between 2003 and 2017. The Transplant Evaluation Rating Scale (TERS) score was prospectively assessed by a psychologist before transplantation, and patients were categorized as low, intermediate, or high risk based on their TERS score. Patients in the high-risk TERS group had significantly longer hospital stays during the first 180 days and 1 year post–allogeneic HSCT compared with the low-risk group (16 vs 13 and 21 vs 16 days; P = .05 and .02, respectively). The survival estimates for low-, intermediate-, and high-risk TERS groups at 3 year were as follows: overall survival (OS), 73%, 60%, and 65%; disease-free survival (DFS), 63%, 55%, and 60%; nonrelapse mortality (NRM), 11%, 20%, and 17%; and relapse, 26%, 25%, and 23%, respectively. In a multivariable analysis, intermediate- and high-risk TERS scores predicted for inferior OS, similar DFS, and higher NRM compared with low-risk TERS score. In a subset analysis of patients with low/intermediate risk per Disease Risk Index, multivariable analysis showed that high- and intermediate-risk TERS scores predicted for significantly worse OS, worse DFS, higher NRM, and similar relapse rates compared with low-risk TERS score. Our findings show that psychosocial factors as measured by TERS score are strong predictors of morbidity and mortality after HSCT among patients with low/intermediate disease risk.

Factor Analyses and Validity of the Transplant Evaluation Rating Scale (TERS) in a Large Sample of Lung Transplant Candidates.

ObjectiveIt is well known that the occurrence of mental disorders is more common in lung transplant candidates compared to the general population. After transplantation mental disorders may negatively affect quality of life, adherence to immunosuppressive medication, as well as overall survival. Therefore, the identification of patients at risk is of utmost importance and in Germany pre-transplant psychosocial evaluation of the patients is required. To ensure high quality and comparability of these assessments, the use of psychometrically sound instruments is recommended. We applied the Transplant Evaluation Rating Scale (TERS), a broadly used expert interview. Two research groups have detected a two-factor structure of the TERS in different transplant samples; however, with slightly different results. The present study investigated which of the models would fit best in our sample of lung transplant patients. Additionally, we assessed convergent and predictive validity of the best fitting model to evaluate its clinical usefulness.MethodsBetween 2016 and 2019, 390 lung transplant candidates were evaluated and included in the study. The median age was 53 years and 54% were male. TERS interviews were conducted by trained medical doctors and psychologists. The participants completed questionnaires assessing quality of life and levels of depression and anxiety. Transplant- and disease-specific variables (lung disease, listing date, oxygen use) were taken from the patient charts. Confirmatory factor analysis was used to test the two proposed TERS-models in the present sample.ResultsThe two-factor structure of the TERS reported by Hoodin and Kalbfleisch fit our sample best, showing good psychometric properties. The factor “emotional sensitivity” was highly correlated with quality of life and measures of psychosocial health while the factor “defiance” correlated with obstructive lung disease and older age but not with quality of life. The two factors showed differential predictive validity with regard to time until listing and pulmonary-specific quality of life 1 year after transplantation.ConclusionsThe two factors showed good psychometric properties, and differential convergent and predictive validity. However, further studies concentrating on the predictive value of the TERS and its factors regarding somatic outcomes (mortality, graft functioning) are required.

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.

Psychological and Social Factors Are a Strong Predictor of Survival after Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) Independent of Disease Risk and Morbidity Score

Psychological and social factors are utilized as important part of the evaluation process for patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). The integration of such factors into the selection of suitable candidates and predicting survival post HSCT is still not widely incorporated in HSCT as it is the case in solid organ transplantation. To evaluate the impact of psycho social risks on post HSCT outcomes such as overall survival (OS), transplant related mortality (TRM), disease free survival (DFS), relapse and length of hospital stay, we prospectively conducted psycho social assessment on 556 consecutive allogeneic HSCT recipients who received their first transplant at our center between 2005 and 2017. The Transplant evaluation rating scale (TERS) has been previously published and was found to be psychometrically sound within the HSCT population(Hoodin, F. and Kalbfleisch, KR., Journal of Psychosomatic Research, 2003.) . TERS score was prospectively assessed by a psychologist prior to transplantation and patients were labeled as low/intermediate risk versus high risk based on their TERS score. All patients were transplanted in the outpatient setting with admission to the inpatient unit if clinically warranted. Five hundred and seven low/intermediate TERS patients and 49 high TERS were included in the analysis. Patients in the low/intermediate risk TERS group were more likely to have a higher disease risk index (17% versus 10%, p<0.001) and more likely to be transplanted in recent years (35% in 2015-207 versus 20% for high risk; p 0.005). Patients in high TERS group had longer, yet not significant, hospital stay during the first 180 days post allogeneic HSCT ( 21 vs 14 days for low/intermediate TERS p=0.22). Both groups had similar median age, sex, disease distribution, donor type, graft source, regimen intensity, HCT-CI score and KPS score. Median follow up for survivors was 66.7 months (14.0-184.4) for low/intermediate risk versus 94.8 months (15.9-182) for high TERS p<0.001. The survival estimates for low/intermediate and high TERS at 1 year were as follows (figure 1): OS (82% vs 63%, p=0.015), DFS (72% vs 57%), TRM (10% vs 16%) and relapse (18% vs 27%). The cumulative incidence of grade 2-4 GVHD and moderate-severe chronic GVHD were 38% and 30% for low/intermediate versus 31% and 27% for high TERS (P=NS). A multivariate analysis using cox models for OS, DFS, TRM, relapse , acute and chronic GVHD was performed using the following variables that were selected based on significance (p<0.05): age (<55 vs ≥55 years), gender, diagnosis, donor type (MRD, MUD, Haplo), source (BM, PBSC), regimen intensity, disease risk (low, intermediate, high), HCT-CI (0-2, ≥3), KPS (60-80, >80) and year of transplant ( 2005-2009, 2010-2014, 2015-2017). High TERS score predicted for worse OS (HR 2.04; 95% CI 1.32-3.17; p=0.002), worse DFS (HR 1.71, 95% CI 1.12-2.63, p0.014), a trend towards higher TRM (HR 1.62, 95% CI 0.86-3.05, p0.136) and relapse (HR 1.56, 95% CI 0.87-2.78, p=0.132) (table 1). In a subset analysis of patients with low/intermediate disease risk, multivariate analysis showed that high TERS predicted for worse OS (HR 1.97, 95% CI1.24-3.14, p=0.004), DFS (HR 1.74, 95% CI 1.10-2.75, p=0.018), trend for higher TRM (HR 1.91, 95% CI 0.98-3.72, p=0.057) and similar relapse rates. 1-year OS and DFS were significantly better for low/intermediate TERS 83% and 75% compared to high TERS 63% and 55% (p<0.05 for both) for patients with low/intermediate disease risk. Among a subset of patients with low HCT-CI ≤2 (n=317), patients in the high TERS group had higher TRM (25% vs 7%, p0.009) but no significant difference in OS, DFS, relapse and GVHD rates. In a multivariate analysis for HCT-CI 0-2 patients, high TERS was significant for higher TRM (HR 2.17, 95% CI 1.45-6.97, p=0.004). Our findings show that psycho social factors as measured by TERS score are a strong predictor of morbidity and mortality after allogeneic HSCT. This effect is independent of disease risk and morbidity prior to transplant. Psycho social factors should be included in patient selection and survival prediction models for transplant recipients. Figure 1: Survival and Relapse Estimates Based on TERS score Disclosures No relevant conflicts of interest to declare.

Prediction of survival on the waiting list for heart transplantation and of posttransplant nonadherence—Results of a prospective longitudinal study

Only a few previous studies have focused on the interaction between pretransplant psychological variables, survival on the waiting list, and adherence to therapy after heart transplantation (HTx). This work combined two studies: Study 1 monitored survival of patients on a HTx waiting list (n=50) and study 2 examined barriers to adherence after HTx (subgroup of n=20). All patients were evaluated immediately after listing for HTx (T0). Those in study 2 were also evaluated immediately after HTx (T1) and after 6months (T2). Psychosocial functioning was measured by the Transplant Evaluation Rating Scale (TERS), and depression and anxiety by Patient Health Questionnaire and Hospital Anxiety and Depression Scale. Barriers to immunosuppressive adherence post-HTx were measured by the Medication Experience Scale for Immunosuppressants (MESI). According to the TERS classification of Rothenhäusler et al, patients were divided into three groups in study 1. Compared with inconspicuous patients (n=23) and risk patients (n=21), high-risk patients (n=6) demonstrated a higher mortality (log-rank test of trend, P=0.002). In study 2, there was a strong correlation between the TERS (T0) and the MESI (T2) (r=0.84, P=0.001). The TERS may serve as a predictor of survival on the waiting list. There is need for further longitudinal data with larger sample sizes.

Correlation Between the Transplant Evaluation Rating Scale (TERS) and Medical Outcomes in Living-Donor Kidney Transplant Recipients: A Retrospective Analysis

BackgroundPretransplant psychosocial evaluation of living-donor kidney transplantation (LDKT) candidates identifies recipients with potentially inferior posttransplant outcomes. Rating instruments, based on semi-standardized interviews, help to improve and standardize psychosocial evaluation. The goal of this study was to retrospectively investigate the correlation between the Transplant Evaluation Rating Scale (TERS) and transplant outcome in LDKT recipients. MethodsTERS scores were retrospectively generated by 2 raters based on comprehensive interviews of 146 LDKT recipients conducted by mental health professionals (interrater reliability, 0.8–0.9). All patients were eligible for transplantation according to pretransplant psychosocial evaluation. Patients were classified into 2 groups according to their TERS scores, in either two thirds excellent risk (TERS <29) and one third at least moderate risk (TERS ≥29) candidates. Analyzed medical parameters were change in estimated glomerular filtration rate and acute rejection (AR) episodes within the first year posttransplant. In addition, a subgroup of 65 patients was tested for de novo donor-specific HLA antibodies (DSA) posttransplant. ResultsThere was no significant difference between the excellent (n = 97) and at least moderate (n = 49) risk candidates according to TERS in terms of organ function (estimated glomerular filtration rate decline >25%: 17 of 97 vs 11 of 49; P = .51) and episodes of AR (19 of 97 vs 15 of 49; P = .15). Patients developing de novo DSA (n = 18 [28%]) did not have higher pretransplant TERS scores (DSA positive, 11 of 42 vs 7 of 23; P = .78). ConclusionsClassifying LDKT recipients according to TERS score did not predict medical outcome at 1 year posttransplant or the occurrence of de novo DSA.

Psychosocial risk predicts high readmission rates for hematopoietic cell transplant recipients.

Hematopoietic cell transplantation (HCT) is an intensive treatment resulting in disease control however subsequent psychosocial distress is common. Screening for psychosocial risk factors that contribute to morbidity is underutilized; moreover, the value in screening is uncertain. We performed a retrospective study of 395 HCT patients who were screened for psychosocial risk using the Transplant Evaluation Rating Scale (TERS). Patients were classified by psychosocial risk as no-risk (TERS = 26.5, 52%) vs. at-risk (TERS > 26.5, 48%), with at-risk patients stratified by cumulative deficits into mild risk (TERS = 27-35.5, 39%) and moderate risk (TERS > 35.5, 9%). At-risk patients were more likely to be readmitted within 90 days (mild risk HR = 1.62, p = 0.02; moderate risk HR = 2.50, p = 0.002). Prior psychiatric history (HR = 1.81, p = 0.002) and poor coping skills (HR = 1.64, p = 0.04) also influenced readmission. At-risk patients were more likely to be readmitted for infection (no-risk = 12% vs. at-risk = 25%, p = 0.002). Pre-HCT screening with the TERS did not predict survival or length of stay although at-risk patients are at a heighted risk of readmission. Implementing strategies to reduce readmission in higher risk patients is warranted.

Psychosocial Risk Is Associated with High Readmission Rates and Increased Length of Stay for Patients Following Hematopoietic Stem Cell Transplantation

Background: Patients undergoing hematopoietic stem cell transplantation (HSCT) are routinely screened for psychological and social risk factors prior to transplantation to determine eligibility and optimize support. Although patients with psychosocial risk factors have been shown to have a higher rate of depression and anxiety, the relationship between psychosocial risk and clinical outcomes in HSCT is not well established. We hypothesized that psychosocially vulnerable patients would be at a higher risk for adverse clinical outcomes including hospital readmission and increased length of stay (LOS) following HSCT.Methods: We performed a retrospective observational study at a single center of 395 consecutive HSCT patients who underwent pre-transplant psychosocial screening using the Transplant Evaluation Rating Scale (TERS). The TERS is a validated screening tool utilized to identify patients who are psychosocially vulnerable (κ=0.89-0.98, α=0.76, p=<0.001). TERS scoring is based on an aggregate of 10 different factors (Axis I diagnosis, Axis II diagnosis, substance abuse, compliance, health behaviors, family/social support, coping history, disease coping, affect quality, and mental status). The primary endpoint was time to readmission or death (TTRD) and was calculated as time from transplant discharge to readmission or death, censoring patients without an event at last follow-up or 90 days post-transplant. Estimates for TTRD were obtained using the Kaplan-Meier method and compared by the log-rank test. Multivariable regression analyses were performed to determine hazard ratios (HR) of TERS adjusting for other important covariates.Results: Patients underwent autologous (n=218, 55%) and allogeneic (n=177, 45%) HSCT for acute leukemia (n=140, 35%), multiple myeloma (n=134, 34%), lymphoma (n=93, 24%) and other indications (n=28, 7%). Patients were classified according to psychosocial risk as no-risk (TERS=26.5, 52%) vs. at-risk (TERS>26.5, 48%), with at-risk patients subdivided into mild risk (TERS=27-35.5, 39%) and moderate risk (TERS>35.5, 9%). Psychiatric conditions (24%), poor health behaviors (16%), and poor coping history (13%) were the most common identified risk factors while substance abuse (7%) and non-compliance (2%) were less frequent. Characteristics were similar among TERS groups with respect to race, disease, remission status, type of HSCT, and graft source. Patients with higher TERS scores tended to be younger (no-risk [median age = 58 years] vs. moderate risk [median age = 50.5 years], p=0.04). In multivariable analysis controlling for comorbidity index and disease type, at-risk patients were significantly more likely to be readmitted within 90 days (mild risk HR=1.53 (95% CI [1.04-2.26], p=0.03), moderate risk HR=1.88 (95% CI [1.08-3.29], p=0.03)). This association held across diseases and HSCT type when examined separately. Additionally, in the multiple myeloma cohort, mild risk patients tended to have longer LOS (mean LOS = 19.06 days) than no-risk patients (mean LOS = 16.78 days, p=0.005). Overall survival did not differ significantly among groups.Conclusion: All patients who are identified pre-transplant to have any degree of psychosocial vulnerability are at higher risk for hospital readmission following HSCT and certain groups are at risk for longer length of stay. Hospital readmission in HSCT patients is associated with poor overall survival, increased cost, and worse quality of life. As many psychosocial risk factors are potentially modifiable, at-risk patients undergoing HSCT would be an ideal population for a prospective study with targeted interventions such as early utilization of cancer psychologists, counselors, or healthcare navigators. Further research needs to be pursued to delineate which, if any, particular psychosocial risk factors are driving this association. [Display omitted] DisclosuresAndritsos:Hairy Cell Leukemia Foundation: Research Funding. Hofmeister:Arno Therapeutics, Inc.: Research Funding; Signal Genetics, Inc.: Membership on an entity’s Board of Directors or advisory committees; Janssen: Pharmaceutical Companies of Johnson & Johnson: Research Funding; Incyte, Corp: Membership on an entity’s Board of Directors or advisory committees; Celgene: Research Funding; Karyopharm Therapeutics: Research Funding; Takeda Pharmaceutical Company: Research Funding; Teva: Membership on an entity’s Board of Directors or advisory committees.

Standardized Evaluation of Candidates Before Liver Transplantation With the Transplant Evaluation Rating Scale

The Transplant Evaluation Rating Scale (TERS) was developed to provide a standardized evaluation of the psychosocial functioning of patients, before transplantation. Yet, the first 2 items of the TERS are based on psychiatric diagnoses referring to Diagnostic and Statistical Manual (DSM)-III-R, which leads to a duplication of disorder-specific and symptom-specific contents, that makes it complex to rate. Moreover, the TERS has not been updated to DSM revisions and DSM is not used for the official clinical routine documentation in several European countries. The objective of this study was, therefore, to investigate the psychometric properties of a diagnoses-corrected version of the TERS (items 1 and 2 omitted). In 85 patients awaiting liver transplantation, the discrimination capacities, predictive value, convergent validity, and interrater reliability of the original version (TERS10) and the diagnoses-corrected version (TERS8) were analyzed. In both versions, patients with psychiatric diagnoses (69.4%) exhibited significantly higher TERS mean values than patients without psychiatric disorders. This also held for patients who were temporarily not found eligible for transplantation in the psychosocial evaluation (25.9%) compared with patients who were eligible for listing for transplantation. Furthermore, the area under the curve was >0.90 for both versions and a cutoff of 32.25 is suggested for TERS8 (sensitivity of 90.9% and specificity of 87.3%). Our results substantiate good psychometric properties of the revised (diagnoses corrected) TERS, which is of great benefit for standardized psychosocial evaluation before liver transplantation. Further, validation of TERS8 and its cutoff in other samples of (liver) transplantation patients is needed.

Predictive value of psychosocial assessment for the mortality of patients waiting for liver transplantation

Selecting suitable candidates for liver transplantation is the most challenging task of pre-transplant evaluation. In addition to somatic assessment, psychosocial evaluation has been proven important in identifying patients at high risk of potential failure. The Transplant Evaluation Rating Scale (TERS) is a widely used rating instrument for the assessment of psychosocial risk factors before liver transplantation. The aim of this study was to explore the predictive value of TERS for mortality in liver transplant patients before and after transplantation. The medical records of patients referred for psychiatric evaluation before liver transplantation between 2003 –2013 were analysed. Administering TERS was part of the pre-transplant evaluation. The TERS scores of patients who died before and after transplantation were compared with those who survived following transplantation. One hundred and sixteen patients were referred for pre-transplant psychiatric evaluation. Patients with successful liver transplants scored significantly lower on TERS than those who died before transplantation (30.65 ± 6.06 vs. 34.75 ± 8.25, p = .031). Patients who died after transplantation scored significantly better on TERS than those who died before transplantation (28.79 ± 2.81 vs. 34.75 ± 8.25, p = .003). There was no significant difference between the deceased and surviving transplanted patients’ TERS scores (28.79 ± 2.81 vs. 31.19 ± 6.66, p = .365). TERS appears to be a suitable rating instrument to help select candidates who have higher chance to survive prior to transplantation but it could not predict post-transplant mortality.

Psychosocial Evaluation in Patients Undergoing Left Ventricular Assist Device Implantation Using the Transplant Evaluation Rating Scale

It has been recommended that all candidates for left ventricular assist device (LVAD) implantation undergo preoperative psychologic evaluation for risk assessment. We used the transplant evaluation rating scale (TERS) that was established for pretransplant evaluation to investigate the psychosocial assessment of patients undergoing LVAD implantation. This study retrospectively analyzed data from 125 patients with advanced heart failure who were evaluated by the TERS before LVAD implantation. Postoperative follow-up included survival, total length of hospital stay, readmissions, and post-LVAD out-of-hospital days after discharge. The cohort was stratified according to the TERS scores into low-, moderate-, and high-risk groups. The outcomes were analyzed to evaluate whether the TERS score was associated with post-LVAD adverse events. The TERS, when stratified into 3 risk groups showed significant difference in 8 of the 10 psychosocial domains (p < 0.001). The mean number of outpatient days after discharge was significantly different between the low-, moderate-, and high-risk groups (p < 0.001). All other outcomes were not significantly different. This study showed that the TERS is successful in stratifying our patients with an LVAD into 3 risk groups, indicating the internal validity of this test. The number of out-of-hospital (outpatient) days after discharge was significantly shorter in the TERS high-risk group, which may affect the quality of life and cost of post-LVAD care.

The Psychosocial Transplant Evaluation Rating Scale (TERS) Prospectively Predicts Inferior Overall Survival Outcome for High Risk Scoring Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

Several studies have begun to examine the relationship between psychosocial variables and outcome in hematopoietic stem cell transplantation (HSCT). Previous studies have also looked at the relationship between the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) and disease risk on overall survival in HSCT. Research has shown that disease risk and HCT-CI may have a negative relationship with outcome in HSCT. In this study, psychosocial data was collected prospectively on 437 patients undergoing related and unrelated allogeneic HSCT. All patients were assessed using the Transplant Evaluation Rating Scale (TERS). Based on the patient’s TERS score, each patient was stratified into one of two groups (low/moderate risk (n=371) vs. high risk (n=66)) based on their predicted psychosocial risk for problems during transplant. The 1-year overall survival (OS) for the low/mod risk TERS group versus the high TERS risk group was 78% and 61%, respectively (p=.005). Stratification by CIBMTR disease risk identified 261 patients with low and intermediate risk disease of which 228 had low/mod risk TERS score and 33 had high risk TERS score. The is a significant survival advantage for Low/Mod Risk TERS patients vs. High Risk TERS patients at 100 day, 1 year and overall survival being 97% vs 79% (P=.01), 85% vs 58% (P=.002) and 68% vs 42% (P=.002) with a median follow up of 48 months (graph attached). An adjusted logistic regression analysis showed that psychosocial factors have a significant impact on overall survival despite all patients being required to have 24 hour caregiver support, a pre-transplant psychosocial evaluation and post-transplant psychosocial intervention. The analysis controlled for other variables such as age, gender, performance status, disease risk and transplant type. These results highlight the impact of psychosocial factors on HSCT outcome, as those patients who are expected to do well based on their low/intermediate disease risk may not perform as expected due to psychosocial risk factors. These results suggest the need to perform careful psychosocial assessments on all HSCT patients in order to predict mortality risks for the individual patient and to help the transplant team strategize how to better manage the high risk psychosocial patient. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Assessing psychosocial vulnerability and care needs of pretransplant patients by means of the INTERMED.

We investigated whether the INTERMED, a generic instrument for assessing biopsychosocial case complexity and direct care, identifies organ transplant patients at risk of unfavourable post-transplant development by comparing it to the Transplant Evaluation Rating Scale (TERS), the established measure for pretransplant psychosocial evaluation. One hundred nineteen kidney, liver, and heart transplant candidates were evaluated using the INTERMED, TERS, SF-36, EuroQol, Montgomery-Åsberg Depression Rating Scale (MADRS), and Hospital Anxiety & Depression Scale (HADS). We found significant relationships between the INTERMED and the TERS scores. The INTERMED highly correlated with the HADS,MADRS, and mental and physical health scores of the SF-36 Health Survey. The results demonstrate the validity and usefulness of the INTERMED instrument for pretransplant evaluation. Furthermore, our findings demonstrate the different qualities of INTERMED and TERS in clinical practice. The advantages of the psychiatric focus of the TERS and the biopsychosocial perspective of the INTERMED are discussed in the context of current literature on integrated care.

Präoperative Evaluation des Körperkonzepts von Nierenlebendspendern und -empfängern

The psychosocial evaluation of the body concept of living kidney donors and recipients is part of a general psychosocial assessment as well as the early detection of organ integration disorders. From 2010 to 2011 we investigated the eligibility for living kidney donation in 36 living kidney donors and 36 recipients using a semistructured clinical interview and the German version of the Transplant Evaluation Rating Scale (TERS). In addition, we used the Fragebogen zum Körperbild (FKB-20) to evaluate body concept. Living kidney donors and recipients differed in their body concept. Living kidney recipients described a body-centered disturbance stemming from a reduction of body-intensive activities including destabilization of body concept. The psychological coping process involved in living kidney donation demands a reconstitution of the body self. The coping/health behavior and the affective state of living kidney recipients are protective factors that influence successful organ integration.

Overall mental distress and health-related quality of life after solid-organ transplantation: results from a retrospective follow-up study

BackgroundOur retrospective follow-up study aimed to explore the degree of overall mental distress in a cohort of solid-organ transplantation (SOT) recipients after liver, heart or lung transplantation. Furthermore, we investigated how overall mental distress is linked to health-related quality of life.Methods123 SOT patients treated during the study period were enrolled in this investigation at a mean of 24.6 months (SD=11.6) after transplantation. Before transplantation, the Transplant Evaluation Rating Scale (TERS) was used to classify the level of adjustment in psychosocial functioning among transplantation candidates. After transplantation, recipients completed a research battery, which included the SCL-90-R, and the SF-36.Results39 (31.7%) transplantation recipients had clinically significant overall mental distress as measured on the Global Severity Index of the SCL-90-R. Obsessive-compulsive symptoms (92.3%), somatization symptoms (87.2%), anxiety symptoms (84.6%), depression symptoms (82.1%) and phobic anxiety symptoms (69.2%) were a frequent finding.Transplantation recipients with overall mental distress had significant lower levels of adjustment in psychosocial functioning before transaplantation than those without overall mental distress as measured in the TERS. Transplantation-related overall mental distress symptomatology was associated with maximal decrements in health-related quality of life.ConclusionTransplantation recipients may face major transplantation- and treatment-related overall mental distress and impairments to their health-related quality of life. Further, overall mental distress is a high-risk factor in intensifying impairments to patients’ overall quality of life.

Posttraumatic stress symptoms after solid-organ transplantation: preoperative risk factors and the impact on health-related quality of life and life satisfaction

BackgroundSolid-organ transplantations (SOT) are usually life-saving high-tech medical procedures. The transplantation itself and the intensive care unit stay could be traumatic stressors triggering posttraumatic stress symptoms (PTSS). Our retrospective follow-up study aimed to explore preoperative risk factors of PTSS in a cohort of SOT recipients, and we investigated how PTSS are associated with health-related quality of life (HRQOL) and life satisfaction.Methods126 SOT recipients were enrolled in this investigation. Psychiatric examination of all SOT candidates based on the Transplant Evaluation Rating Scale was carried out before SOT, and after SOT, recipients completed the PTSS-10, the SF-36 and the FLZ.ResultsAfter the surgical intervention 19 (15.1%) SOT recipients had clinical significant PTSS. Preoperative risk factors for developing postoperative PTSS were: 1.) preexisting psychiatric morbidity, 2.) history of retransplantation, 3.) chronic benzodiazepine consumption, 4.) age, and 5.) type of transplantation.SOT-related PTSS were associated with maximal decrements in HRQOL and life satisfaction. The following HRQOL and life satisfaction domains were affected: Physical Functioning, Role Physical, Pain, General Health, Vitality, Social Functioning, Role Emotional, Mental Health, Occupation/Work and Character/Own Skills.ConclusionSOT recipients may face a major risk of transplantation- and treatment-related PTSS and the development of impairments to HRQOL and life satisfaction.