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Nguyen L, Forte A, Malat G, Liu X, Rivera J, Christopher C, Samudralwar R, Ilori T, Norris M, Bleicher M, Redfield RR, Weinrieb R, Bloom RD, Dunn TB, Trofe-Clark J. Program Evaluation of Pharmacist-Performed Medication Adherence Assessments in Candidates for Living Donor Kidney Transplant. Prog Transplant 2024:15269248241268681. [PMID: 39095045 DOI: 10.1177/15269248241268681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Introduction: Medication education and adherence assessments are integral to kidney transplant success. This program evaluation aimed to describe candidate-reported findings using a standardized medication adherence assessment in candidates undergoing living-donor kidney transplantation. Design: This was a single-center retrospective description of medication adherence on adult HIV-negative living-donor candidates from July 1, 2018 to December 1, 2018 who had ≥6 months post-operative follow-up. Medication adherence assessments were performed by a pharmacist at the pre-operative visit within 2 weeks prior to transplant. Candidates were considered to (a) have adherence concerns if they reported missed/late medications within 2 weeks of assessment or ever stopped a medication without medical advice and (b) considered using adherence strategies if they reported active use of pill box, method to keep track of refills/auto-refill use, medication list, or medication reminder(s). Missed medication data were collected at 3- and 6-months posttransplant. Results: Among 181 candidates included, 81 (45%) had adherence concerns and 169 (93%) reported using adherence strategies. There were no significant differences with adherence concerns by age ≤ 29 years, sex, race, prior transplant/dialysis, or less than a high school education. More candidates with greater than a high school education used adherence strategies (96% vs 86%, P = .002). Too few candidates had documentation on missing medications at 3 and 6 months. Conclusions: Over 40% of candidates reported characteristics concerning medication nonadherence despite over 90% reporting adherence strategies used. Medication adherence assessments can assist with identification of medication nonadherence and education individualization.
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Affiliation(s)
- Linh Nguyen
- Department of Pharmacy Services, Hospital of University of Pennsylvania, Philadelphia, PA, USA
| | - Abigail Forte
- Department of Pharmacy Services, Hospital of University of Pennsylvania, Philadelphia, PA, USA
- Penn Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory Malat
- Department of Pharmacy Services, Hospital of University of Pennsylvania, Philadelphia, PA, USA
- Penn Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Xinqi Liu
- Department of Pharmacy Services, Hospital of University of Pennsylvania, Philadelphia, PA, USA
| | - Jose Rivera
- Department of Pharmacy Services, Hospital of University of Pennsylvania, Philadelphia, PA, USA
| | - Cara Christopher
- Department of Pharmacy Services, Hospital of University of Pennsylvania, Philadelphia, PA, USA
| | - Rahul Samudralwar
- Department of Pharmacy Services, Hospital of University of Pennsylvania, Philadelphia, PA, USA
- Penn Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Tolulope Ilori
- Department of Pharmacy Services, Hospital of University of Pennsylvania, Philadelphia, PA, USA
| | - Maxwell Norris
- Department of Pharmacy Services, Hospital of University of Pennsylvania, Philadelphia, PA, USA
- Penn Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Melissa Bleicher
- Penn Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Renal, Electrolyte, and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert R Redfield
- Penn Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Department of Surgery, Division of Transplantation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Weinrieb
- Penn Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Roy D Bloom
- Penn Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Renal, Electrolyte, and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ty B Dunn
- Penn Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Department of Surgery, Division of Transplantation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer Trofe-Clark
- Department of Pharmacy Services, Hospital of University of Pennsylvania, Philadelphia, PA, USA
- Penn Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Renal, Electrolyte, and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Surgery, Division of Transplantation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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2
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Zanatta E, Patron E, Messerotti Benvenuti S, Pelizzaro F, Russo FP, Gambato M, Germani G, Ferrarese A, Zanetto A, Battermann F, Buccheri F, Cavalli C, Schiavo R, Ghisi M, Pasquato S, Feltracco P, Cillo U, Burra P, Senzolo M. Alcoholic Etiology, Severity of Liver Disease, and Post-Transplant Adherence Are Correlated with Worse Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) in Liver Transplant Candidates. J Clin Med 2024; 13:3807. [PMID: 38999373 PMCID: PMC11242210 DOI: 10.3390/jcm13133807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/14/2024] Open
Abstract
Introduction: Psychosocial pre-transplant evaluation in patients undergoing liver transplantation (LT) could help identify those patients at higher risk of pharmacological non-adherence, organ rejection, and mortality. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a validated tool for assessing LT candidates' psychosocial well-being. Data on the ability of the SIPAT evaluation to predict post-transplant outcomes are sparse. Material and Methods: clinical and psychosocial data from a sample of 134 candidates for LT were analyzed. Moreover, the association between pre-transplant psychosocial evaluation and post-transplant clinical outcomes, including organ rejection, mortality, and immunosuppressant drug adherence, was calculated. Results: At the pre-transplant evaluation, patients who showed high SIPAT scores (77, 57%) also had more liver disease assessed by model for end-stage liver disease (MELD; F = 5.04; p < 0.05), alcoholic etiology (F = 35.80; p < 0.001), encephalopathy (F = 5.02; p < 0.05), and portal hypertension (F = 7.45; p < 0.01). Of the 51 transplant patients, those who had a high pre-transplant SIPAT score showed lower post-transplant immunosuppressive adherence, linked to more frequent immunological events. Conclusions: Patients with an alcoholic etiology of liver disease and more severe liver dysfunction are likelier to not adhere to medical prescriptions following transplantation. Current data suggests that this specific group of patients could benefit from early psychological pre-habilitation before undergoing liver transplantation.
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Affiliation(s)
- Elisa Zanatta
- Multivisceral Transplant Unit-Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, 35128 Padua, Italy
| | - Elisabetta Patron
- Department of General Psychology, University of Padua, 35151 Padua, Italy
| | - Simone Messerotti Benvenuti
- Department of General Psychology, University of Padua, 35151 Padua, Italy
- Hospital Psychology Unit, Padua University Hospital, 35128 Padua, Italy
- Padova Neuroscience Center (PNC), University of Padua, 35131 Padua, Italy
| | - Filippo Pelizzaro
- Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, 35128 Padua, Italy
| | - Francesco Paolo Russo
- Multivisceral Transplant Unit-Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, 35128 Padua, Italy
| | - Martina Gambato
- Multivisceral Transplant Unit-Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, 35128 Padua, Italy
| | - Giacomo Germani
- Multivisceral Transplant Unit-Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, 35128 Padua, Italy
| | - Alberto Ferrarese
- Multivisceral Transplant Unit-Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, 35128 Padua, Italy
| | - Alberto Zanetto
- Multivisceral Transplant Unit-Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, 35128 Padua, Italy
| | | | | | - Chiara Cavalli
- Hospital Psychology Unit, Padua University Hospital, 35128 Padua, Italy
| | - Rossana Schiavo
- Hospital Psychology Unit, Padua University Hospital, 35128 Padua, Italy
| | - Marta Ghisi
- Department of General Psychology, University of Padua, 35151 Padua, Italy
- Hospital Psychology Unit, Padua University Hospital, 35128 Padua, Italy
| | - Sara Pasquato
- Hospital Psychology Unit, Padua University Hospital, 35128 Padua, Italy
| | - Paolo Feltracco
- Department of Medicine, UO Anesthesia and Intensive Care, University of Padua, 35128 Padua, Italy
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplant Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit-Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, 35128 Padua, Italy
| | - Marco Senzolo
- Multivisceral Transplant Unit-Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, 35128 Padua, Italy
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Wang RX, Lee JJ, Mirda D, Hao J, Goebel AM, Deutsch-Link S, Serper M, Bittermann T. Association of psychosocial risk factors and liver transplant evaluation outcomes in metabolic dysfunction-associated steatotic liver disease. Liver Transpl 2024:01445473-990000000-00401. [PMID: 38869989 DOI: 10.1097/lvt.0000000000000421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/31/2024] [Indexed: 06/15/2024]
Abstract
The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a standardized psychosocial assessment tool used in liver transplantation (LT) evaluation and has been primarily studied in patients with alcohol-associated liver disease. We aimed to evaluate the relationship between SIPAT score and metabolic syndrome severity and LT waitlist outcomes in a large cohort of patients with metabolic dysfunction-associated steatotic liver disease (MASLD). We performed a single-center retrospective cohort study of patients with MASLD evaluated for LT from 2014 to 2021. The utility of the previously defined total SIPAT cutoff (<21 [excellent/good candidates] vs. ≥21 [minimally acceptable/high-risk candidates]) was studied. Multivariable logistic regression analyses examined associations between continuous SIPAT scores and LT waitlisting outcomes. The Youden J statistic was used to identify the optimal SIPAT cutoff for patients with MASLD. A total of 480 patients evaluated for transplant with MASLD were included. Only 9.4% of patients had a SIPAT score ≥21. Patients with SIPAT score ≥21 had higher hemoglobin A1c compared to patients with lower psychosocial risk (median [IQR]: 7.8 [6.0-9.7] vs. 6.6 [5.8-7.9]; p = 0.04). There were no other differences in metabolic comorbidities between SIPAT groups. Increasing SIPAT score was associated with decreased odds of listing (OR: 0.82 per 5-point increase; p = 0.003) in multivariable models. A SIPAT of ≥12 was identified as the optimal cutoff in this population, resulting in an adjusted OR for a listing of 0.53 versus SIPAT <12 ( p = 0.001). In this large cohort of patients with MASLD evaluated for LT, few patients met the previously defined high SIPAT cutoff for transplant suitability. Nevertheless, increasing the SIPAT score was associated with waitlist outcomes. Our suggested SIPAT cutoff of ≥12 for patients with MASLD warrants further external validation using data from other centers.
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Affiliation(s)
- Roy X Wang
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason J Lee
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Danielle Mirda
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jinxuan Hao
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anna M Goebel
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sasha Deutsch-Link
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Marina Serper
- Division of Gastroenterology and Hepatology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Therese Bittermann
- Division of Gastroenterology and Hepatology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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4
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Punt SE, Caicedo MR, Rhodes AC, Ilardi SS, Hamilton JL. A semi-structured interview is associated with bariatric surgery outcomes. J Behav Med 2024; 47:483-491. [PMID: 38393445 DOI: 10.1007/s10865-024-00471-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 01/18/2024] [Indexed: 02/25/2024]
Abstract
Pre-surgical psychological evaluations (PSPE) are required by many insurance companies and used to help identify risk factors that may compromise bariatric post-surgical outcomes. These evaluations, however, are not yet standardized. The present study investigated the utility of a semi-structured assessment, Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), on post-surgical outcomes across 18 months. A total of 272 adult patients underwent a psychosocial evaluation and received bariatric surgery November 2017 to September 2020 at a Midwestern academic medical center. Average age at pre-surgical evaluation was 45.2 (SD = 10.7) years and 82.3% of patients were female (n = 224). With an a priori α of 0.05, multi-level modeling with weight as the outcome and regression with complications as the outcome were used. Higher SIPAT Patient Readiness, indicating difficulty with adhering to health behaviors and a reduced understanding of bariatric surgery, was associated with elevated patient weight at the 18-month follow-up (𝛽 = 0.129, p = 0.03). Higher SIPAT Social Support, was associated with patient weight at the 18-month follow-up, with reduced support associated with greater weight (𝛽 = 0.254, p = 0.004). Higher SIPAT Social Support also was associated with a greater risk of complications across the 18-month follow-up window (𝛽 = -0.108, p = 0.05). Patients with higher readiness to adhere to behavioral changes, and those reporting an intact social support system, generally weighed less at 18 months. The SIPAT may be considered as part of the standardized pre-surgical assessment, however, further research is required to elucidate its utility.
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Affiliation(s)
- Stephanie E Punt
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90024, USA.
| | - Mariana Rincon Caicedo
- Department of Psychology, University of Kansas, 1415 Jayhawk Blvd, Lawrence, KS, 66045, USA
| | - Ashley C Rhodes
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Stephen S Ilardi
- Department of Psychology, University of Kansas, 1415 Jayhawk Blvd, Lawrence, KS, 66045, USA
| | - Jessica L Hamilton
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
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5
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Kim JS, Wray J, Ridout D, Plumb L, Nitsch D, Robb M, Marks SD. Protocol for a multicentre prospective exploratory mixed-methods study investigating the modifiable psychosocial variables influencing access to and outcomes after kidney transplantation in children and young people in the UK. BMJ Open 2024; 14:e078150. [PMID: 38806415 PMCID: PMC11138291 DOI: 10.1136/bmjopen-2023-078150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 05/02/2024] [Indexed: 05/30/2024] Open
Abstract
INTRODUCTION Kidney transplantation is the preferred therapy for children with stage 5 chronic kidney disease (CKD-5). However, there is a wide variation in access to kidney transplantation across the UK for children. This study aims to explore the psychosocial factors that influence access to and outcomes after kidney transplantation in children in the UK using a mixed-methods prospective longitudinal design. METHODS Qualitative data will be collected through semistructured interviews with children affected by CKD-5, their carers and paediatric renal multidisciplinary team. Recruitment for interviews will continue till data saturation. These interviews will inform the choice of existing validated questionnaires, which will be distributed to a larger national cohort of children with pretransplant CKD-5 (n=180) and their carers. Follow-up questionnaires will be sent at protocolised time points regardless of whether they receive a kidney transplant or not. Coexisting health data from hospital, UK renal registry and National Health Service Blood and Transplant registry records will be mapped to each questionnaire time point. An integrative analysis of the mixed qualitative and quantitative data will define psychosocial aspects of care for potential intervention to improve transplant access. ANALYSIS Qualitative data will be analysed using thematic analysis. Quantitative data will be analysed using appropriate statistical methods to understand how these factors influence access to transplantation, as well as the distribution of psychosocial factors pretransplantation and post-transplantation. ETHICS AND DISSEMINATION This study protocol has been reviewed by the National Institute for Health Research Academy and approved by the Wales Research Ethics Committee 4 (IRAS number 270493/ref: 20/WA/0285) and the Scotland A Research Ethics Committee (ref: 21/SS/0038). Results from this study will be disseminated across media platforms accessed by affected families, presented at conferences and published in peer-reviewed journals.
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Affiliation(s)
- Ji Soo Kim
- Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Deborah Ridout
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, UCL, London, UK
| | - Lucy Plumb
- UK Renal Registry, Bristol, UK
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Dorothea Nitsch
- UK Renal Registry, Bristol, UK
- Non-communicable disease epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew Robb
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK
| | - Stephen D Marks
- Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
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Wang J, Okoh AK, Chen Y, Steinberg RS, Gangavelli A, Patel KJ, Ko YA, Alexis JD, Patel SA, Vega DJ, Daneshmand M, Defilippis EM, Breathett K, Morris AA. Association of Psychosocial Risk Factors With Quality of Life and Readmissions 1 Year After LVAD Implantation. J Card Fail 2024:S1071-9164(24)00120-9. [PMID: 38621441 DOI: 10.1016/j.cardfail.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 02/29/2024] [Accepted: 03/12/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Among patients with advanced heart failure (HF), treatment with a left ventricular assist device (LVAD) improves health-related quality of life (HRQOL). We investigated the association between psychosocial risk factors, HRQOL and outcomes after LVAD implantation. METHODS A retrospective cohort (n = 9832) of adults aged ≥ 19 years who received durable LVADs between 2008 and 2017 was identified by using the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). Patients were considered to have psychosocial risk factors if ≥ 1 of the following were present: (1) substance abuse; (2) limited social support; (3) limited cognitive understanding; (4) repeated nonadherence; and (5) major psychiatric disease. Multivariable logistic and linear regression models were used to evaluate the association between psychosocial risk factors and change in Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 scores from baseline to 1 year, persistently poor HRQOL (KCCQ-12 score < 45 at baseline and 1 year), and 1-year rehospitalization. RESULTS Among the final analytic cohort, 2024 (20.6%) patients had ≥ 1 psychosocial risk factors. Psychosocial risk factors were associated with a smaller improvement in KCCQ-12 scores from baseline to 1 year (mean ± SD, 29.1 ± 25.9 vs 32.6 ± 26.1; P = 0.015) for a difference of -3.51 (95% confidence interval [CI]: -5.88 to -1.13). Psychosocial risk factors were associated with persistently poor HRQOL (adjusted odds ratio [aOR] 1.35, 95% confidence interval [CI] 1.04-1.74), and 1-year all-cause readmission (adjusted hazard ratio [aHR] 1.11, 95% CI 1.05-1.18). Limited social support, major psychiatric disorder and repeated nonadherence were associated with persistently poor HRQOL, while major psychiatric disorder was associated with 1-year rehospitalization. CONCLUSION The presence of psychosocial risk factors is associated with lower KCCQ-12 scores and higher risk for readmission at 1 year after LVAD implantation. These associations are statistically significant, but further research is needed to determine whether these differences are clinically meaningful.
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Affiliation(s)
- Jeffrey Wang
- Emory University School of Medicine, Division of Cardiology, Atlanta, GA
| | - Alexis K Okoh
- Emory University School of Medicine, Division of Cardiology, Atlanta, GA
| | - Yuxuan Chen
- Emory University Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Atlanta, GA
| | | | - Apoorva Gangavelli
- Emory University School of Medicine, Division of Cardiology, Atlanta, GA
| | - Krishan J Patel
- Emory University School of Medicine, Division of Cardiology, Atlanta, GA
| | - Yi-An Ko
- Emory University Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Atlanta, GA
| | - Jeffrey D Alexis
- University of Rochester Medical Center, Division of Cardiology, Rochester, NY
| | - Shivani A Patel
- Emory University Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA
| | - David J Vega
- Emory University School of Medicine, Department of Surgery, Atlanta, GA
| | - Mani Daneshmand
- Emory University School of Medicine, Department of Surgery, Atlanta, GA
| | - Ersilia M Defilippis
- Center for Advanced Cardiac Care, Columbia University Irving Medical Center, Division of Cardiology, New York, NY
| | - Khadijah Breathett
- Indiana University School of Medicine, Division of Cardiology, Indianapolis, IN
| | - Alanna A Morris
- Emory University School of Medicine, Division of Cardiology, Atlanta, GA.
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Perry JM, Deutsch-Link S, Marfeo E, Serper M, Ladin K. Assessing reliability and validity of SIPAT and opportunities for improvement: A single-center cohort study. Liver Transpl 2024; 30:356-366. [PMID: 37938131 DOI: 10.1097/lvt.0000000000000299] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023]
Abstract
Psychosocial assessment is a standard component of patient evaluations for transplant candidacy. The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) is a widely used measure to assess psychosocial risk for transplant. However, there are questions regarding the SIPAT's reliability and validity. We examined the SIPAT's psychometric performance and its impact on equitable access to transplant in a diverse cohort of 2825 patients seeking liver transplantation between 2014 and 2021 at an urban transplant center. The SIPAT demonstrated good internal consistency reliability at the overall score [Cronbach's α = 0.85, 95% CI (0.83, 0.86)] and domain levels (0.80 > α > 0.70). There was mixed support for structural validity, with poor overall model fit in confirmatory factor analysis and 50% of questions achieving the 0.70-factor loadings threshold. Adjusting for sociodemographic variables, the odds of not being waitlisted for psychosocial reasons were three times higher for patients with Medicaid insurance than patients with private insurance [OR 3.24, 95% CI (2.09, 4.99)] or Medicare [OR 2.89, 95% CI (1.84, 4.53)], mediated by higher SIPAT scores. Black patients had nearly twice the odds of White patients [OR 1.88, 95% CI (1.20, 2.91)], partially mediated by higher social support domain scores. Patients with Medicaid, non-White patients, and those without a college degree scored significantly higher on collinear questions, disproportionately contributing to higher SIPAT scores. The SIPAT did not perform equally across insurance type, race/ethnicity, and education groups, with the lowest subgroup validity associated with patient readiness and psychopathology domains. The SIPAT should be interpreted with caution, especially as a composite score. Future studies should examine validity in other populations.
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Affiliation(s)
- Jennifer M Perry
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
| | - Sasha Deutsch-Link
- Division of Gastroenterology & Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Elizabeth Marfeo
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
| | - Marina Serper
- Division of Gastroenterology & Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Keren Ladin
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
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8
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Westall GP, Barnes H, Levin K, Gaffney N, Harris J, Martinez O, Emsley C, Fuller L, Levvey B, Snell GI, Winton-Brown T. Utility of the Stanford Integrated Psychosocial Assessment for Transplant in predicting outcomes before and after lung transplantation. J Heart Lung Transplant 2024; 43:571-579. [PMID: 38000763 DOI: 10.1016/j.healun.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/29/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Optimizing donor use and achieving maximal survival following lung transplantation (LTx) require a pretransplant assessment that identifies clinical, physiological, and psychosocial patient factors associated with both poor and optimal post-LTx survival. We examined the utility of a psychosocial tool, the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT), to identify patient suitability for LTx, as well as its association with clinical outcomes before and after LTx. METHODS This was a retrospective single-center study analyzing LTx assessment clinical variables (age, gender, diagnosis, functional capacity, nutrition, renal function), with a particular focus on the utility of the SIPAT score, to predict patient suitability for LTx. The same variables were analyzed against LTx waitlist mortality, as well as post-LTx survival. RESULTS Over an 8-year period dating from December 2012, 914 patients (male 54.4%, mean age 55.2 years) underwent LTx assessment. Patients declined for LTx (n = 152, 16.6%) were older and had reduced functional capacity, nutritional markers, and renal function but had a higher SIPAT score. Once listed for LTx, a higher SIPAT score was not associated with waitlist mortality or reduced post-LTx survival. CONCLUSIONS The SIPAT tool measures psychosocial suitability for transplantation that can be incorporated into a standardized assessment of LTx suitability. While patients with higher SIPAT score were more likely to be declined for LTx, the SIPAT score did not predict outcome in transplanted patients. A subgroup of patients with high SIPAT scores were successfully transplanted, suggesting that unfavorable psychosocial variables are potentially modifiable with a well-resourced multidisciplinary LTx team.
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Affiliation(s)
- Glen P Westall
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia.
| | - Hayley Barnes
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia
| | - Kovi Levin
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia
| | - Nicole Gaffney
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia
| | - Jane Harris
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia
| | - Otto Martinez
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia
| | - Christie Emsley
- Department of Nutrition, Alfred Health, Melbourne, Australia
| | - Louise Fuller
- Central Clinical School, Monash University, Melbourne, Australia; Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Bronwyn Levvey
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia
| | - Greg I Snell
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia
| | - Toby Winton-Brown
- Central Clinical School, Monash University, Melbourne, Australia; Department of Psychiatry, Alfred Health, Melbourne, Australia
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Polomeni A, Ainaoui M, Berr A, de Bentzman N, Denis M, Friser V, Magro L, Yakoub-Agha I. [Allogeneic hematopoietic stem cell transplantation and treatment with CAR-T cells - identification of psycho-social vulnerability factors: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]. Bull Cancer 2024; 111:S67-S77. [PMID: 37169605 DOI: 10.1016/j.bulcan.2023.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 05/13/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (HCT) and CAR-T cells therapy are treatments with curative aim for certain hematological malignancies, refractory or relapse. Nevertheless, they carry the risk of morbidity and mortality and may have a significant psychosocial impact, particularly for HCT. It is therefore necessary to identify psychological difficulties and social problems, as well as the patient's resources, and those of his entourage, in order to improve his overall management. The objective of this evaluation is not to pose contraindications to treatments, but to adapt the personalized care project. This identification must be carried out early on in the pre-HCT assessment journey to enable the implementation of appropriate actions by the various care providers. Based on a review of the literature, we designed a psychosocial data collection grid that can be initiated in pre-transplant and updated by accompanying the patient at each stage of follow-up (discharge from hospital, day-hospital follow-up, D100 evaluation). This grid is divided into 3 axes: socio-family context, psychological and somatic aspects. This tool allows the traceability of the interventions of different professionals and is a support for multidisciplinary exchanges.
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Affiliation(s)
- Alice Polomeni
- Assistance publique-Hôpitaux de Paris, hôpital St-Antoine, service d'hématologie clinique et thérapie cellulaire, 184, rue du faubourg St-Antoine, 75012 Paris, France.
| | - Malika Ainaoui
- CHU de Lille, service des maladies du sang, rue Michel-Polonoski, 59037 Lille cedex, France
| | - Aurélie Berr
- Institut de cancérologie Strasbourg Europe, service des soins de support, 17, rue Albert-Calmette BP 23025, 67033 Strasbourg cedex, France
| | - Natacha de Bentzman
- IUCT Oncopole 1, service hématologie-greffe, avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - Marie Denis
- Pôle régional de cancérologie, rue de la Milétrie, 86000 Poitiers, France
| | - Valérie Friser
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpétrière, service d'hématologie clinique, 43-83, boulevard de l'hôpital Pavillon Georges-Heuyer, 75013 Paris, France
| | - Leonardo Magro
- CHU de Lille, service des maladies du sang, rue Michel Polonoski, 59037 Lille cedex, France
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Hinton-Froese KE, Teh L, Henderson DR, Hage CA, Chernyak Y. Associations between the stanford integrated psychosocial assessment for transplant and one-year lung transplant medical and psychosocial outcomes. J Behav Med 2024; 47:102-110. [PMID: 37306859 PMCID: PMC10258482 DOI: 10.1007/s10865-023-00427-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) is a standardized measure of the psychosocial risk profile of solid organ transplant candidates. While studies have found associations between this measure and transplant outcomes, to date this has not been examined in lung transplant recipients. We examined relations between pre-transplant SIPAT scores and 1-year lung transplant medical and psychosocial outcomes in a sample of 45 lung transplant recipients. The SIPAT was significantly associated with 6-minute walk test (χ2(1) = 6.47, p = .010), number of readmissions (χ2(1) = 6.47, p = .011), and mental health services utilization (χ2(1) = 18.15, p < .001). It was not a significantly associated with the presence of organ rejection or mortality (ps > 0.10). Results suggest that the SIPAT can help identify patients who are at an elevated risk for transplant complications and thus would benefit from services to mitigate risk factors and improve outcomes.
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Affiliation(s)
- Kendra E Hinton-Froese
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St, Indianapolis, IN, 4620246202, USA.
| | - Lisa Teh
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, 10461, The Bronx, NY, USA
- Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, 10461, The Bronx, NY, USA
| | - Danielle R Henderson
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St, Indianapolis, IN, 4620246202, USA
| | - Chadi A Hage
- Division of Pulmonary, Allergy, and Critical Care Medicine, Lung Transplant, University of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yelena Chernyak
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St, Indianapolis, IN, 4620246202, USA
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11
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Takano K, Kobayashi S, Oshibuchi H, Tsutsui J, Mishima N, Ito S, Kamba R, Akaho R, Nishimura K. Association of the Stanford Integrated Psychosocial Assessment for Transplant and 1-Year Outcome of Living Kidney Transplantation in Japan. J Acad Consult Liaison Psychiatry 2024; 65:14-24. [PMID: 37778460 DOI: 10.1016/j.jaclp.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/16/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Because most kidney transplantations in Japan are performed on the basis of living donors, after-transplant outcomes should achieve optimum results, overcoming participants' possible reduced adherence. OBJECTIVE To investigate the association between the Japanese version of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT-J) and outcomes, 1 year after the patient's living kidney transplant (LKT). METHODS The prospective cohort study was undertaken at Tokyo Women's Medical University Hospital from January 2020 to July 2021, with a 1-year follow-up period. The SIPAT-J assesses 18 psychosocial risk factors: (1) Patient's Readiness Level and Illness Management (SIPAT A), (2) Social Support System Level of Readiness (SIPAT B), (3) Psychological Stability and Psychopathology (SIPAT C), and (4) Lifestyle and Effect of Substance Use (SIPAT D). The evaluators, a psychiatrist and 3 clinical psychologists, conducted an independent, blinded application of the SIPAT-J using participants' medical records. The study focused on physical composite outcomes, psychiatric outcomes, and nonadherent behaviors. RESULTS The participants were 173 LKT recipients (median age [interquartile range], 51 [38-59]); 67.1% were male and 67.1% were employed. The median (interquartile range) SIPAT scores were SIPAT A [7 (5-9)], SIPAT B [7 (5-9)], SIPAT C [2 (0-4)], SIPAT D [3 (3-4)], and SIPAT total [20 (16-23)]. The physical composite outcome was 25 (14.5%), psychiatric outcome 9 (5.2%), and nonadherent behavior 17 (9.8%). SIPAT C (odds ratio = 1.34, 95% confidence interval = 1.06-1.72, P = 0.02) was significantly associated with the psychiatric outcome. SIPAT B (odds ratio = 1.49, 95% confidence interval = 1.12-1.98, P = 0.01) and SIPAT total (odds ratio = 1.13, 95% confidence interval = 1.03-1.24, P = 0.01) were significantly associated with nonadherent behaviors. There was no significant association between the SIPAT and physical composite outcomes. CONCLUSION This study is the first to examine the association between SIPAT and physical and psychiatric outcomes 1 year after LKT, controlling for follow-up periods and factors other than SIPAT. Comprehensive psychosocial assessment before LKT and early identification of factors that may negatively affect transplant success can allow targeted interventions to be implemented and increase the likelihood of favorable recipient outcomes.
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Affiliation(s)
- Kosuke Takano
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Sayaka Kobayashi
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan; Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.
| | - Hidehiro Oshibuchi
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan.
| | - Junko Tsutsui
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan; Department of Psychology, Faculty of Human Science, Denen-chofu University, Kawasaki City, Japan
| | - Nano Mishima
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Satoko Ito
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Rumiko Kamba
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Rie Akaho
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
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Kosaraju R, Vandenbogaart E, Core E, Creaser J, Livingston N, Moore M, Kamath M, Deng M. Higher-risk SIPAT score predicts increased risk of long-term mortality in orthotopic heart transplant recipients. Int J Cardiol 2023; 393:131360. [PMID: 37709206 DOI: 10.1016/j.ijcard.2023.131360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/02/2023] [Accepted: 09/11/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Orthotopic heart transplantation (OHT) improves survival in eligible patients. Organ scarcity necessitates extensive clinical and psychosocial evaluations before listing. The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) predicts risk for poor psychosocial outcomes and morbidity in the first year post-transplant, yet it is unknown whether it predicts long-term outcomes. METHODS Blinded examiners obtained data from a retrospective cohort of 51 OHT recipients from a high-volume center. Patients with "Excellent" or "Good" SIPAT score indicating low psychosocial risk for transplant (E/G) were compared with those who met "Minimum Acceptable Criteria" or were "High Risk" (MAC/HR). Associations were examined between SIPAT group and outcomes. RESULTS MAC/HR versus E/G recipients had significantly reduced survival in the 10 years post-OHT (mean 6.7 vs 8.8 years, p = 0.027; 55% vs 82% survival proportions, p = 0.037). MAC/HR patients were more likely to live in a county with greater income inequality (p = 0.025) and have psychiatric history pre-OHT (p = 0.046). Both groups had otherwise similar demographics and medical history. A lower proportion of MAC/HR patients adhered to medications post-OHT and a greater proportion had psychiatric illness, though differences were not significant. CONCLUSIONS Higher-risk SIPAT scores predict reduced long-term survival post-OHT. Further efforts are crucial to improve outcomes in higher-risk patients.
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Affiliation(s)
- Revanth Kosaraju
- Department of Medicine, Division of Cardiology, University of California Los Angeles, Los Angeles, CA 90095, United States of America.
| | - Elizabeth Vandenbogaart
- Department of Medicine, Division of Cardiology, University of California Los Angeles, Los Angeles, CA 90095, United States of America
| | - Erin Core
- Department of Medicine, Division of Cardiology, University of California Los Angeles, Los Angeles, CA 90095, United States of America
| | - Julie Creaser
- Department of Medicine, Division of Cardiology, University of California Los Angeles, Los Angeles, CA 90095, United States of America
| | - Nancy Livingston
- Department of Medicine, Division of Cardiology, University of California Los Angeles, Los Angeles, CA 90095, United States of America
| | - Melissa Moore
- Department of Medicine, Division of Cardiology, University of California Los Angeles, Los Angeles, CA 90095, United States of America
| | - Megan Kamath
- Department of Medicine, Division of Cardiology, University of California Los Angeles, Los Angeles, CA 90095, United States of America
| | - Mario Deng
- Department of Medicine, Division of Cardiology, University of California Los Angeles, Los Angeles, CA 90095, United States of America
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Thode S, Perry K, Cyr S, Ducharme A, Puissant D, Brouillette J. Psychosocial assessment tools for use before transplantation are predictive of post-operative psychosocial and health behavior outcomes: a narrative review of the literature. FRONTIERS IN TRANSPLANTATION 2023; 2:1250184. [PMID: 38993930 PMCID: PMC11235356 DOI: 10.3389/frtra.2023.1250184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/14/2023] [Indexed: 07/13/2024]
Abstract
Introduction 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. Methods 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]). Results 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. Discussion 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.
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Affiliation(s)
- Sorin Thode
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
| | - Keith Perry
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Samuel Cyr
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | - Anique Ducharme
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | - David Puissant
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
| | - Judith Brouillette
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
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Güneş D, Erci B, Uncu F, Saritaş S. Turkish Validity and Reliability Study of the Scale of Psychosocial Assessment of Candidates for Transplantation (PACT). Transplant Proc 2023; 55:1530-1534. [PMID: 37380589 DOI: 10.1016/j.transproceed.2023.03.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/30/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION According to the results of this study, evidence of the validity and reliability of the PACT was obtained.
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Affiliation(s)
- Dilek Güneş
- Department of Surgical Nursing, Fırat University, Faculty of Health Sciences, Elazığ, Turkey.
| | - Behice Erci
- Department of Public Health Nursing, Inonu University, Faculty of Nursing, Malatya, Turkey
| | - Fatoş Uncu
- Department of Public Health Nursing, Fırat University, Faculty of Health Sciences, Elazığ, Turkey
| | - Serdar Saritaş
- Department of Surgical Nursing, Inonu University, Faculty of Nursing, Malatya, Turkey
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Teh L, Henderson D, Hage C, Chernyak Y. Interitem Psychometric Validation of the Stanford Integrated Assessment for Transplant Scale Among Thoracic Transplant Candidates. J Acad Consult Liaison Psychiatry 2023; 64:418-428. [PMID: 36521680 DOI: 10.1016/j.jaclp.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 10/14/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Psychosocial evaluations are mandatory for transplant listing, however the methodology for creating psychosocial risk stratifications is unclear. The Standford Psychosocial Integrated Psychosocial Assessment for Transplant Scale is the most commonly used instrument, however its interitem validity has never been examined. OBJECTIVE To investigate the interitem validity of a psychosocial assessment tool for transplant candidates among a sample of thoracic transplant candidates. METHODS Clinic data consisting of Stanford Integrated Psychosocial Assessment for Transplant administrations from 173 heart and lung transplant candidates were fit to a partial credit model. Data were subsequently fit to 4 separate partial credit models based on subscale categories, demonstrating the discrimination parameter estimate of each item. Differential item functioning analyses were conducted on the data within each subscale by sex to investigate potential bias produced by each item. RESULTS The initial partial credit model using the full scale did not converge, indicating the subscales possibly did not measure the same underlying construct. Subscale discrimination parameter estimates demonstrated that most items were adequately or highly discriminative. The item measuring history of substance use demonstrated poor fit and differential item functioning. CONCLUSIONS While the Stanford Integrated Psychosocial Assessment for Transplant has demonstrated strong potential as a standardized framework for psychosocial assessments in transplant, this study identified some areas for improvement in the scoring system. The subscale scores appeared to show greater construct validity when utilized individually than when aggregated to form a total score. The substance use/abuse/dependence item did not fit well into its respective subscale. Future studies should aim to optimize the scoring system and re-asses its construct validity to improve its accuracy in discriminating between high-risk candidates and those needing psychosocial assistance.
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Affiliation(s)
- Lisa Teh
- Montefiore Medical Center, Department of Psychiatry and Behavioral Sciences, Bronx, NY; Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, NY; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN.
| | - Danielle Henderson
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Chadi Hage
- Department of Pulmonology, Allergy, and Critical Care, Indiana University, Indianapolis, IN
| | - Yelena Chernyak
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
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Takano K, Oshibuchi H, Kobayashi S, Tsutsui J, Ito S, Kamba R, Akaho R, Nishimura K. Characterization of the stanford integrated psychosocial assessment for transplant for heart, liver, and kidney transplant candidates in Japan. Biopsychosoc Med 2023; 17:24. [PMID: 37461076 DOI: 10.1186/s13030-023-00281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a comprehensive psychosocial assessment proven useful for predicting the outcomes of organ transplantation that is expected to be useful in Japan. However, the characteristics of organ-specific SIPAT scores for organ transplant recipient candidates in Japan are unclear and, to date, the SIPAT has not been properly utilized in clinical practice. The purpose of this study was to present basic data that can be used to establish the relation between SIPAT scores and post-transplantation psychosocial outcomes as well as organ-specific outcomes. METHODS This study included 167 transplant recipient candidates (25 heart, 71 liver, and 71 kidney) who completed a semi-structured interview based on the Japanese version of SIPAT (SIPAT-J) prior to transplantation. The differences between organs in terms of SIPAT scores and differences in SIPAT scores based on demographic data were comparatively analyzed. RESULTS The total SIPAT scores were higher for liver recipient candidates than for heart recipient candidates (P = .019). Regarding the subscales, SIPAT B (social support system) scores were higher for liver and kidney recipient candidates than for heart recipient candidates (P = .021), whereas SIPAT C (psychological stability and psychopathology) scores were higher for liver recipient candidates than for kidney recipient candidates (P = .002). Recipient candidates with a history of psychiatric treatment and those who were unemployed had higher SIPAT scores, regardless of the transplant organ, than recipient candidates without a history of psychiatric treatment and those who were employed (P < .001, P = .016, respectively). CONCLUSIONS There were notable differences in the total SIPAT-J and subscale scores among the liver, heart, and kidney recipient candidates. Each organ was associated with specific psychosocial issues that should be addressed before transplantation. Interventions such as information provision and patient education based on SIPAT assessment results for each organ may improve recipient post-transplant outcomes.
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Affiliation(s)
- Kosuke Takano
- Department of Psychiatry, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hidehiro Oshibuchi
- Department of Psychiatry, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Sayaka Kobayashi
- Department of Psychiatry, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Kamoda, Kawagoe-shi, Saitama, Saitama, 1981, 350-8550, Japan
| | - Junko Tsutsui
- Department of Psychiatry, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
- Faculty of Human Science, Denen-chofu University, 3-4-1 Higashiyurigaoka, Asao-ku, Kawasaki City, Kawasaki-shi, Kanagawa, 215-8542, Japan
| | - Satoko Ito
- Department of Psychiatry, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Rumiko Kamba
- Department of Psychiatry, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Rie Akaho
- Department of Psychiatry, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Durkin C, Bittermann T. Liver transplantation for alcohol-associated hepatitis. Curr Opin Organ Transplant 2023; 28:85-94. [PMID: 36512482 PMCID: PMC9992110 DOI: 10.1097/mot.0000000000001044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Early liver transplantation is emerging as a treatment option for severe alcohol-associated hepatitis refractory to pharmacotherapies. This review outlines the current status of transplantation for alcohol-associated hepatitis and the treatment of alcohol use disorder after liver transplantation. RECENT FINDINGS Rates of early liver transplantation for alcohol-associated hepatitis are increasing with significant heterogeneity in practices across the Unites States. Recent studies have demonstrated a substantial survival benefit in patients transplanted for alcohol-associated hepatitis with improved outcomes in early vs. late transplantation, first vs. prior hepatic decompensation, and posttransplant abstinence/delayed relapse vs. early return to alcohol use. Several prediction algorithms have been developed to ascertain patients' risk of alcohol relapse and aid in candidate selection, though data on treatment of alcohol use disorders in transplant recipients remains limited. SUMMARY Although controversial, early liver transplantation for severe alcohol-associated hepatitis has shown to be a lifesaving intervention. Additional research is needed to evaluate its long-term outcomes, optimize candidate selection, and understand treatment of alcohol use disorder posttransplant.
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Affiliation(s)
- Claire Durkin
- Department of Medicine, Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Therese Bittermann
- Department of Medicine, Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
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Mancini D, Moss N. Commentary: Bringing objectivity to the nonmedical evaluation of left ventricular assist device candidates. J Thorac Cardiovasc Surg 2023; 165:1123-1124. [PMID: 34154802 DOI: 10.1016/j.jtcvs.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Donna Mancini
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Noah Moss
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
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Zanowski SC, Price JS, Selim MA, Schumann V, Durazo F, Hong JC. Effect of an Integrated Transplantation Mental Health Program on Alcohol Relapse After Liver Transplantation for Severe Alcoholic Hepatitis: A Single-Center Prospective Study. Transplant Proc 2022; 54:2627-2633. [DOI: 10.1016/j.transproceed.2022.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/21/2022]
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20
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Weiss E, Kabacam G, Gorvin L, Spiro M, Raptis DA, Keskin O, Orloff S, Belghiti J. The role of preoperative psychosocial counseling on the improvement of the recipient compliance and speed of recovery after liver transplantation - A systematic review of the literature and expert panel recommendations. Clin Transplant 2022; 36:e14632. [PMID: 35253275 DOI: 10.1111/ctr.14632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/28/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Psychosocial disorders ranging from anxiety to severe psychiatric diseases and active alcohol/substance abuse are frequent in liver transplant candidates and potentially associated with worse post- transplant outcomes. Therefore, psychosocial evaluation is mandatory to optimize success after liver transplantation. However, how to carry out this evaluation, the type of intervention needed and its potential impact on patient outcome remain unclear. OBJECTIVES To investigate whether psychosocial assessment may help in predicting risks of poor outcome; and to investigate whether psychosocial interventions may mitigate these risks and improve posttransplant outcomes, in particular compliance and speed of recovery. DATA SOURCES Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central. METHODS Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. The protocol was registered on PROSPERO CRD42021238361. Main outcomes assessed were mortality, alcohol relapse, rejection, and medication compliance. RESULTS Fifteen studies were analyzed including five observational comparative and ten observational noncomparative studies. Preoperative psychosocial evaluation of LT candidates was associated with higher concordance with the treatment plan (i.e., higher adherence to treatment and lower alcohol relapse) and lower rates of rejection. Psychosocial assessment tools were used in some studies to guide the evaluation, but their predictive ability remains debated, and they should not be used in isolation. Most of the interventions were studied in patients with alcohol related issues. In this context, support by specialized teams was associated with better posttransplant outcome, especially through a decrease in post-transplant alcohol relapse. CONCLUSIONS Preoperative psychosocial assessment should be provided in order to detect patients at increased risk of poorer post-transplant outcome, in particular in terms of concordance to the treatment plan (Quality of Evidence; Low | Grade of Recommendation; Strong/For). The experts suggest that, when possible, provision of preoperative psychological assessment and concomitant interventions aimed at improving the concordance to treatment plans will positively impact the success of liver transplantation. (Quality of Evidence; Very Low | Grade of Recommendation; Strong/For].
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Affiliation(s)
- Emmanuel Weiss
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord and Paris University, Clichy, France
| | - Gokhan Kabacam
- Division of Internal Medicine, Yuksek Ihtisas University School of Medicine, Ankara, Turkey.,Department of Gastroenterology, Guven Hospital, Ankara, Turkey
| | - Lucy Gorvin
- Liver Transplant Psychology, Royal Free Hospital, London, UK
| | - Michael Spiro
- Department of Anesthesia and Intensive Care Medicine, Royal Free Hospital, London, UK.,Division of Surgery & Interventional Science, University College London, London, UK
| | - Dimitri Aristotle Raptis
- Division of Surgery & Interventional Science, University College London, London, UK.,Clinical Service of HPB Surgery and Liver Transplantation, Royal Free Hospital, London, UK
| | - Onur Keskin
- Division of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Susan Orloff
- Department of Surgery, Division of Abdominal Organ Transplantation/Hepatobiliary Surgery, Portland, Oregon, USA
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21
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Morais-DE-Jesus M, Jesus-Nunes AP, Codes L, Argolo FC, Quarantini LC. MENTAL DISORDERS AND LIVER TRANSPLANTATION: A 2-YEAR COHORT STUDY. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:494-500. [PMID: 36515345 DOI: 10.1590/s0004-2803.202204000-88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Psychosocial assessment is a key component in evaluation for liver transplantation and may affect survival rates and outcomes. OBJECTIVE The primary aim of this study was to investigate the impact of previous mental disorders and impulsivity on the 2-year surviving rate after liver transplantation. METHODS We performed a prospective cohort study assessing end-stage liver disease individuals with and without psychiatric comorbidities for 2 years post-transplant. Psychiatric diagnosis was carried out through Mini-Plus 5.0.0 and impulsivity by using Barratt Impulsiveness Scale in the pre-transplant phase. We followed patient's status for 2 years after transplantation. The main outcome was death. We used a logistic regression to evaluate the association of psychiatric comorbidities with death and performed a survival analysis with Kaplan-Meier and Cox regression models. RESULTS Between June 2010 and July 2014, 93 out of 191 transplant candidates received transplants. From the 93 transplant patients, 21 had psychiatric comorbidities and 72 had not. 25 patients died during the study. The presence of psychiatric comorbidities (P=0.353) and high impulsivity (P=0.272) were not associated to 2-year post transplant death. CONCLUSION This study found no evidence that the presence of mental disorders and impulsivity worsened prognosis in post-liver transplantation.
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Affiliation(s)
- Mychelle Morais-DE-Jesus
- Universidade Federal da Bahia, Programa de Pós-Graduação em Medicina e Saúde, Salvador, BA, Brasil
| | - Ana P Jesus-Nunes
- Universidade Federal da Bahia, Programa de Pós-Graduação em Medicina e Saúde, Salvador, BA, Brasil
| | - Liana Codes
- Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Serviço de Hepatologia, Salvador, BA, Brasil
| | - Felipe C Argolo
- Universidade Federal de São Paulo, Departamento de Psiquiatria, Pós-graduação de Psiquiatria e Psicologia Médica, São Paulo, SP, Brasil
| | - Lucas C Quarantini
- Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria de Salvador, Salvador, BA, Brasil
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22
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Horrell J, Callaghan L, Dhanda A. Alcohol misuse in patients with alcohol-related liver disease: How can we do better? A narrative review of the literature. Alcohol Clin Exp Res 2022; 46:1364-1370. [PMID: 35766348 PMCID: PMC9543176 DOI: 10.1111/acer.14895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ongoing alcohol use is strongly associated with progressive liver damage and higher mortality in patients with alcohol-related liver disease (ArLD). Reduction in alcohol use is therefore the cornerstone of treatment to improve the long-term outcome of these patients. However, a large proportion of patients continue to use alcohol and do not access or engage with alcohol treatment services after a diagnosis of ArLD. We reviewed the literature on factors associated with ongoing alcohol consumption among patients with ArLD to identify barriers or facilitators to their accessing alcohol treatment. METHODS A search of MEDLINE and EMBASE was conducted using search strategies relating to ArLD and the psychosocial factors hypothesized to influence alcohol reduction and/or abstinence. RESULTS There were few relevant studies pertinent to this population group. Several studies reported a high prevalence of mental health diagnoses associated with the severity of alcohol dependence. Social and environmental factors were shown to be important determinants of alcohol use. Common themes perceived as barriers to treatment from qualitative interviews with ArLD patients across studies included poor communication between the clinical team and patient, lack of symptoms recognized by patients themselves, and perceived loss of control over their condition. CONCLUSIONS We recommend that future clinical studies of patient cohorts with ArLD include detailed psychosocial assessments to capture information on mental health and social factors. Qualitative studies are required to explore the patient journey pre and post hospital admission, which should focus on identifying facilitators and barriers to accessing treatment. Well-designed, controlled studies are needed to identify patient, social, and environmental factors associated with relapse to alcohol use after a diagnosis of ArLD. These data will enable us to adapt our support for patients to enhance engagement with services and improve long-term outcomes.
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Affiliation(s)
- Jane Horrell
- Peninsula Medical School, Faculty of HealthUniversity of PlymouthPlymouthUK
| | - Lynne Callaghan
- Peninsula Medical School, Faculty of HealthUniversity of PlymouthPlymouthUK
| | - Ashwin Dhanda
- Peninsula Medical School, Faculty of HealthUniversity of PlymouthPlymouthUK,South West Liver UnitUniversity Hospitals Plymouth NHS TrustPlymouthUK
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23
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Daniel KE, Matthews LA, Deiss-Yehiely N, Myers J, Garvey M, Rice JP, Eickhoff J, Lucey MR. Psychosocial Assessment Rather Than Severity of Liver Failure Dominates Selection for Liver Transplantation in Patients With Alcohol-Related Liver Disease. Liver Transpl 2022; 28:936-944. [PMID: 34596955 DOI: 10.1002/lt.26324] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 09/10/2021] [Accepted: 09/17/2021] [Indexed: 12/12/2022]
Abstract
The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) is a validated interview tool to assess psychosocial well-being in candidates for solid organ transplants, with higher scores indicating greater vulnerability. We hypothesized that patients with alcohol-related liver disease (ALD) undergoing liver transplantation (LT) evaluation would have higher SIPAT scores than candidates with non-ALD, but that only patients with ALD who have low scores would be selected. We analyzed retrospectively consecutive adults undergoing LT evaluation from June 2018 to December 2019. Comparisons between patients with ALD and patients with non-ALD were made using the nonparametric Wilcoxon rank sum test plus a multivariate analysis to determine independent predictors for approval. In the study cohort of 358 patients, there were 199 (56%) patients with ALD with a mean age of 55 years, and 133 (67%) were men. There were 159 (44%) patients with non-ALD with a mean age of 57 years, and 95 (60%) were men. Mean Model for End-Stage Liver Disease-sodium scores were similar for selected versus not selected patients with ALD (25 versus 25.6) and selected versus not selected patients with non-ALD (18.3 versus 17.4), although the ALD group had substantially higher Model for End-Stage Liver Disease scores. Patients with ALD had higher mean SIPAT composite and individual domain scores compared with their non-ALD counterparts. SIPAT scores were not affected by age or sex. Proportionately more candidates with non-ALD were selected compared to candidates with ALD (68% versus 42%; P < 0.001; odds ratio for approval of non-ALD versus ALD, 2.9; 95% confidence interval, 1.8-4.7; P < 0.001). Composite SIPAT scores were lower in the selected versus nonselected in both ALD and non-ALD groups, although the SIPAT scores were significantly higher in selected patients with ALD (median, 39) than selected patients with non-ALD (median, 23; P = 0.001). Psychosocial assessment has a greater influence than acuity of liver failure on the selection of patients with ALD for LT listing, whereas psychosocial assessment has a minor influence on the selection of non-ALD candidates.
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Affiliation(s)
- Kimberly E Daniel
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Lindsay A Matthews
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Nimrod Deiss-Yehiely
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jaime Myers
- Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Maureen Garvey
- Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - John P Rice
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jens Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Michael R Lucey
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI
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24
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Robiner WN, Petrik ML, Flaherty N, Fossum TA, Freese RL, Nevins TE. Depression, Quantified Medication Adherence, and Quality of Life in Renal Transplant Candidates and Recipients. J Clin Psychol Med Settings 2022; 29:168-184. [PMID: 34089133 PMCID: PMC8642472 DOI: 10.1007/s10880-021-09792-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 11/26/2022]
Abstract
Like patients with many chronic illnesses, ESRD patients experience psychological challenges with greater incidence of depression and reduced quality of life (QoL). A series of 139 transplant candidates' depression and QoL, and a subset of 82 candidates' medication adherence were monitored, revealing heterogenous patterns of depression and adherence and reduced QoL. Twenty-eight patients who received kidney transplants were re-evaluated 6 months post-transplant revealing mixed patterns. Mean depression and quantitated adherence decreased and QoL increased. Some patients improved whereas others declined in depression and adherence. Pre-transplant depression was negatively correlated with post-transplant adherence but positively correlated with post-transplant depression. Nevertheless, the ability to predict individuals' post-transplant adherence and depression, principal objectives of pre-transplant psychological evaluations, is limited. Consequently, it is important to provide periodic screening of ESRD patients for depression and adherence pre- and post-transplant as they reflect changing states, rather than static traits, with variable patterns across patients.
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Affiliation(s)
- William N Robiner
- Health Psychology, Division of General Internal Medicine, Department of Medicine, University of Minnesota Medical School, MMC 741, 420 Delaware Street, S.E, Minneapolis, MN, 55455, USA.
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Megan L Petrik
- Health Psychology, Division of General Internal Medicine, Department of Medicine, University of Minnesota Medical School, MMC 741, 420 Delaware Street, S.E, Minneapolis, MN, 55455, USA
| | - Nancy Flaherty
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Thyra A Fossum
- Health Psychology, Division of General Internal Medicine, Department of Medicine, University of Minnesota Medical School, MMC 741, 420 Delaware Street, S.E, Minneapolis, MN, 55455, USA
| | - Rebecca L Freese
- Biostatistical Design and Analysis Center (BDAC), Clinical and Translational Science Institute (CTSI), University of Minnesota, Minneapolis, MN, USA
| | - Thomas E Nevins
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
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25
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Punt SE, Rhodes AC, Ilardi SS, Hamilton JL. Use of the Stanford Integrative Psychosocial Assessment for Transplant as a Pre-surgical Psychological Evaluation Tool for Bariatric Surgery. J Clin Psychol Med Settings 2022; 29:808-817. [DOI: 10.1007/s10880-022-09850-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 11/30/2022]
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26
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Steinberg RS, Nayak A, Burke MA, Aldridge M, Laskar SR, Bhatt K, Sridharan L, Abdou M, Attia T, Smith A, Daneshmand M, Vega JD, Gupta D, Morris AA. Association of race and gender with primary caregiver relationships and eligibility for advanced heart failure therapies. Clin Transplant 2022; 36:e14502. [PMID: 34634150 PMCID: PMC8752502 DOI: 10.1111/ctr.14502] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/25/2021] [Accepted: 10/04/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Caregiver support is considered necessary after heart transplant (HT) and left ventricular assist device (LVAD) for patients with end-stage heart failure (HF). Few studies have demonstrated how caregivers differ by gender and race, and whether that impacts therapy eligibility. METHODS We examined caregiver relationships among 674 patients (32% women, 55% Black) evaluated at Emory University from 2011 to 2017. Therapy readiness was assessed using the Stanford Integrated Assessment for Transplant (SIPAT). Evaluation outcome according to caregiver relationship was compared using χ2 analysis. Multivariable logistic regression determined the association between caregiver and eligibility according to gender and race. RESULTS Women and Black patients were less likely to have spouses as their support person (P < .001). Women were less likely to be considered eligible for advanced therapies (adjusted odds ratio [aOR] .64, 95% confidence interval [CI] .46-.89; P = .008), with Black women having lower eligibility than White women (aOR .28, 95% CI .11-.72; P = .008). Social support and SIPAT scores did not significantly influence eligibility by gender or race. CONCLUSION Lack of caregiver support is considered a relative contraindication to advanced therapies. Type of caregiver in our cohort varied according to race and gender but did not explain differences in eligibility for advanced therapies.
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Affiliation(s)
| | - Aditi Nayak
- Emory University, Division of Cardiology, Atlanta GA
| | - Michael A. Burke
- Emory University, Division of Cardiology, Atlanta GA,Emory Transplant Center, Emory Healthcare, Atlanta GA
| | - Morgan Aldridge
- Emory University, Division of Cardiology, Atlanta GA,Emory Transplant Center, Emory Healthcare, Atlanta GA
| | - S. Raja Laskar
- Emory University, Division of Cardiology, Atlanta GA,Emory Transplant Center, Emory Healthcare, Atlanta GA
| | - Kunal Bhatt
- Emory University, Division of Cardiology, Atlanta GA,Emory Transplant Center, Emory Healthcare, Atlanta GA
| | - Lakshmi Sridharan
- Emory University, Division of Cardiology, Atlanta GA,Emory Transplant Center, Emory Healthcare, Atlanta GA
| | - Mahmoud Abdou
- Emory University, Division of Cardiology, Atlanta GA,Emory Transplant Center, Emory Healthcare, Atlanta GA
| | - Tamer Attia
- Emory Transplant Center, Emory Healthcare, Atlanta GA,Emory University, Division of Surgery, Atlanta GA
| | - Andrew Smith
- Emory University, Division of Cardiology, Atlanta GA,Emory Transplant Center, Emory Healthcare, Atlanta GA
| | - Mani Daneshmand
- Emory Transplant Center, Emory Healthcare, Atlanta GA,Emory University, Division of Surgery, Atlanta GA
| | - J. David Vega
- Emory University, Division of Cardiology, Atlanta GA,Emory Transplant Center, Emory Healthcare, Atlanta GA
| | - Divya Gupta
- Emory University, Division of Cardiology, Atlanta GA,Emory Transplant Center, Emory Healthcare, Atlanta GA
| | - Alanna A. Morris
- Emory University, Division of Cardiology, Atlanta GA,Emory Transplant Center, Emory Healthcare, Atlanta GA
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27
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Integration of addiction treatment and behavioral therapies in comprehensive liver transplantation care to augment adherence and reduce alcohol relapse. JOURNAL OF LIVER TRANSPLANTATION 2022. [DOI: 10.1016/j.liver.2021.100061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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28
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Dienstag A, Dienstag P, Mohan K, Mirza O, Schubert E, Ford L, Edelman M, Im G, Shenoy A. An Assessment of the Psychosocial Evaluation for Early Liver Transplantation in Patients With Acute Alcoholic Hepatitis in the Context of Alcohol Use Disorder, a Case-Control Study. Subst Abuse 2022; 16:11782218221115659. [PMID: 35966615 PMCID: PMC9373124 DOI: 10.1177/11782218221115659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 07/07/2022] [Indexed: 11/25/2022]
Abstract
Background: Severe acute alcoholic hepatitis (AAH) has an extremely poor prognosis with a
high short term mortality rate. As a result, many centers, including our
own, have allowed transplant patients to be listed for transplantation prior
to achieving 6-months of sobriety. Several scoring systems, designed to
target patients with a minimal period of sobriety, have been proposed to
identify patients with alcohol use disorder (AUD), who would be predisposed
to relapse after liver transplantation. We investigated whether these
scoring systems corroborated the results of the non-structured selection
criteria used by our center regarding decision to list for transplant. Methods: We conducted a retrospective case-control study of 11 patients who underwent
early liver transplantation for AAH matched with 11 controls who were
declined secondary to low insight into AUD. Blinded raters confirmed the
severity of the diagnosis of DSM-5 and scored the patients on a variety of
structured psychometric scales used to predict alcohol relapse. These
included the High Risk for Alcohol Relapse Scale (HRAR), Stanford Integrated
Psychosocial Assessment Tool (SIPAT), Alcohol Relapse Risk Assessment
(ARRA), Hopkins Psychosocial Scale (HPSS), Michigan Alcoholism Prognosis
Score (MAPS), Alcohol Use Disorders Identification Test -Consumption
(AUDIT-C), and Sustained Alcohol Use Post-Liver Transplant (SALT) scales.
All patients who underwent transplantation were followed for harmful and
non-harmful drinking until the end of the study period. Results: The transplant recipients had significantly favorable MAPS, HRAR, SIPAT,
ARRA, and HPSS scores with cutoffs that matched their previous research. The
SALT and AUDIT-C scores were not predictive of our selection of patients for
transplantation. Despite an expedited evaluation and no significant period
of sobriety, our case cohort had a 30% relapse to harmful drinking after an
average of 6.6 years (5-8.5 years) of follow-up. Discussion: Despite the rapid assessment and the short to no period of sobriety, the
patient cohort demonstrated a 30% relapse to harmful drinking, consistent
with the 20% to 30% relapse to drinking rate reported after liver
transplantation for all forms of alcoholic liver disease. Average scores
from MAPS, HRAR, SIPAT, ARRA, and HPSS corroborated our current
stratification procedures, with lower mean risk scores found in the
transplanted group. Conclusion: Patients with AUD and severe AAH who obtain new insight into their disease
and posses other favorable psychosocial factors have low rates of AUD
relapse post-liver-transplantation. The psychosocial selection criteria for
patients with alcoholic hepatitis in our institution are consistent with 4
of the 5 scoring systems investigated in their prediction of sobriety
post-transplant.
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Affiliation(s)
- Aryeh Dienstag
- Department of Psychiatry, Hadassah Hebrew University School of Medicine, Jerusalem, Israel
| | - Penina Dienstag
- Department of Anesthesia, Hadassah Hebrew University School of Medicine, Jerusalem, Israel
| | - Kanwal Mohan
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Omar Mirza
- Department of Psychiatry, Harlem Hospital Center, New York, NY, USA
| | - Elizabeth Schubert
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Laura Ford
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Margot Edelman
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Gene Im
- Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Akhil Shenoy
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
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29
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Satoko I, Oshibuchi H, Tsutsui J, Kobayashi S, Takano K, Sugawara H, Kamba R, Akaho R, Ishida H, Maldonado J, Nishimura K. Psychosocial Assessment of Transplant Candidates: Inter-rater Reliability and Concurrent Validity of the Japanese Version of the Stanford Integrated Psychosocial Assessment for Transplantation. J Acad Consult Liaison Psychiatry 2021; 63:345-353. [PMID: 34863909 DOI: 10.1016/j.jaclp.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/19/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a comprehensive instrument developed to provide a standardized, objective, and evidence-based psychosocial evaluation of the main pretransplant psychosocial risk factors that may influence transplant outcomes. OBJECTIVE Because established assessment procedures or standardized tools designed to perform pre-solid organ transplant psychosocial evaluation are currently unavailable in Japan, the present study aimed to develop and preliminarily validate the Japanese version of the SIPAT. METHODS First, the Japanese version of the SIPAT was developed using standard forward-back-translation procedures. Then, the Japanese versions of the SIPAT and the Japanese version of Psychosocial Assessment of Candidates for Transplant were retrospectively and blindly applied to 107 transplant cases by 4 independent raters. RESULTS The interrater reliability of the scores obtained with the Japanese version of the SIPAT was excellent (Pearson's correlation coefficient = 0.86). The concurrent validity of the SIPAT to the Psychosocial Assessment of Candidates for Transplant for each examiner was substantial (Spearman's rank correlation coefficient = -0.66). CONCLUSION These findings suggest that the Japanese version of the SIPAT is a promising and reliable instrument. Further research is required to test the predictive validity of the Japanese version of the SIPAT.
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Affiliation(s)
- Ito Satoko
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Hidehiro Oshibuchi
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan; Department of Child Psychiatry, Kanagawa Children's Medical Center, Yokohama-shi, Kanagawa, Japan.
| | - Junko Tsutsui
- Faculty of Human science Denen-chofu University, Kawasaki city, Japan
| | - Sayaka Kobayashi
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Kosuke Takano
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroko Sugawara
- Department of Psychiatry, Kansai Rosai Hospital, Amagasaki, Japan; Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Rumiko Kamba
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Rie Akaho
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Jose Maldonado
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
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30
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Bailey P, Vergis N, Allison M, Riddell A, Massey E. Psychosocial Evaluation of Candidates for Solid Organ Transplantation. Transplantation 2021; 105:e292-e302. [PMID: 33675318 DOI: 10.1097/tp.0000000000003732] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Transplant candidates should undergo an assessment of their mental health, social support, lifestyle, and behaviors. The primary aims of this "psychosocial evaluation" are to ensure that transplantation is of benefit to life expectancy and quality of life, and to allow optimization of the candidate and transplant outcomes. The content of psychosocial evaluations is informed by evidence regarding pretransplant psychosocial predictors of transplant outcomes. This review summarizes the current literature on pretransplant psychosocial predictors of transplant outcomes across differing solid organ transplants and discusses the limitations of existing research. Pretransplant depression, substance misuse, and nonadherence are associated with poorer posttransplant outcomes. Depression, smoking, and high levels of prescription opioid use are associated with reduced posttransplant survival. Pretransplant nonadherence is associated with posttransplant rejection, and nonadherence may mediate the effects of other psychosocial variables such as substance misuse. There is evidence to suggest that social support is associated with likelihood of substance misuse relapse after transplantation, but there is a lack of consistent evidence for an association between social support and posttransplant adherence, rejection, or survival across all organ transplant types. Psychosocial evaluations should be undertaken by a trained individual and should comprise multiple consultations with the transplant candidate, family members, and healthcare professionals. Tools exist that can be useful for guiding and standardizing assessment, but research is needed to determine how well scores predict posttransplant outcomes. Few studies have evaluated interventions designed to improve psychosocial functioning specifically pretransplant. We highlight the challenges of carrying out such research and make recommendations regarding future work.
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Affiliation(s)
- Pippa Bailey
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Renal and Transplant Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Nikhil Vergis
- Liver Services Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Metabolism Digestion and Reproduction, Imperial College London, UK
| | - Michael Allison
- Cambridge Liver Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Amy Riddell
- Renal and Transplant Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
- University of Exeter Medical School, Exeter, UK
| | - Emma Massey
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
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31
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Recommendations for Psychosocial Evaluation of VAD candidates: Adoption, completion, and barriers to implementation. Heart Lung 2021; 51:52-58. [PMID: 34731698 DOI: 10.1016/j.hrtlng.2021.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/12/2021] [Accepted: 10/17/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recommendations exist to guide clinicians on a comprehensive psychosocial (PS) evaluation prior to Mechanical Circulatory Support (MCS) implantation. OBJECTIVES Assess adoption, beliefs, methodologies, and barriers to completion of the 2018 ISHLT/APM/AST/ICCAC/STSW Recommendations for Psychosocial evaluation of adult cardiothoracic transplant and long term mechanical circulatory support. METHODS Cross-sectional survey distributed to all 183 implanting LVAD centers in North America via mail and email. RESULTS Total of 58 Programs (35.6% response rate) representing 29 states and all regions of the United States responded. Respondents reported implanting 1,183 adults (range 0 - 85; mean = 21.5, SD = 18) in 2018. A majority (n = 55, 94.8%) reported that the 2018 Recommendations were consistent with their clinical practice and most (n = 51, 87.9%) had adopted the recommendations. The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) (n = 25, 47.1%) was the most commonly cited assessment tool in the use, although 15 centers reported utilizing more than one tool during the assessment process. Most common barriers influencing completion of the PS evaluation include patient too ill (total responses = 104), lack of time (total responses = 89), patient poor candidate (total responses = 44), and lack of Insurance coverage/reimbursement (total responses = 41). CONCLUSION The 2018 ISHLT Recommendations for PS evaluation of LVAD Candidates are widely adopted by respondents in clinical practice, although barriers are still reported to their implementation. Additional research is needed to understand strategies to reduce barriers to implementation and maintenance of the recommendations in clinical practice.
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32
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Lichvar A, Chandran MM, Do V, Rendulic T, Szczepanik A, Pierce D, Park JM. Entrustable professional activities for pharmacy students: A primer for solid organ transplant preceptors. Am J Health Syst Pharm 2021; 78:zxab320. [PMID: 34350946 DOI: 10.1093/ajhp/zxab320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Indexed: 11/14/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE The role of a solid organ transplant pharmacist is multifaceted and translates to diverse experiential and elective learning experiences that can be provided to pharmacy learners. Here we provide a guide to integrating pharmacy students into patient care and other pharmacist activities in solid organ transplantation. SUMMARY Thoughtful incorporation of learners into clinical practice and clinical research creates a positive learning environment for pharmacy students that can foster the development of core skills necessary for students to become "practice-ready" and "team-ready" pharmacy graduates and can equip them with valuable skills to incorporate into the specialty practice areas and careers they pursue. To help develop these educational experiences, attention to the list of core entrustable professional activities (EPAs) established by the American Association of Colleges of Pharmacy can help create a rich environment of learning with carefully cultivated tasks. Furthermore, learners can serve as transplant pharmacist extenders to assist in overall patient care and multidisciplinary involvement on the transplant team. This article serves as a "how-to" guide for applying the EPA framework to integrating pharmacy students in patient care and other pharmacist activities in solid organ transplantation and other specialty practice areas. CONCLUSION As pharmacy preceptors design and operationalize their teaching to incorporate EPAs, they can benefit from recommendations tailored to specialty practice areas such as solid organ transplantation. Students may start and finish these experiences at different EPA levels, but continuance of training will allow them to achieve the final EPA level across the 6 EPA domains.
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Affiliation(s)
- Alicia Lichvar
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, and Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Vincent Do
- Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, USA
| | - Trisann Rendulic
- Department of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Amanda Szczepanik
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA
| | - Dana Pierce
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, USA
| | - Jeong M Park
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, and Department of Pharmacy Services, Michigan Medicine, Ann Arbor, MI, USA
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Ting PS, Gurakar A, Wheatley J, Chander G, Cameron AM, Chen PH. Approaching Alcohol Use Disorder After Liver Transplantation for Acute Alcoholic Hepatitis. Clin Liver Dis 2021; 25:645-671. [PMID: 34229846 PMCID: PMC8264137 DOI: 10.1016/j.cld.2021.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Severe alcoholic hepatitis portends a high risk of mortality without liver transplantation. Transplant outcomes in patients with severe alcoholic hepatitis exhibit a strong inverse association with post-transplant alcohol relapse. The ingredients most central to ameliorating alcohol relapse risk may include destigmatized post-transplant alcohol monitoring, a nonpunitive clinician-patient partnership, and multimodal therapies to maintain abstinence and mitigate high-risk drinking. We here review the core principles of post-liver transplant management specific to alcohol use disorder.
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Affiliation(s)
- Peng-Sheng Ting
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 431, Baltimore, MD 21287, USA
| | - Ahmet Gurakar
- Liver Transplant, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Research Building, Suite 918, Baltimore, MD 21205, USA.
| | - Jason Wheatley
- Department of Social Work, Johns Hopkins Hospital, 600 North Wolfe Street, Carnegie Suite 100, Baltimore, MD 21287, USA
| | - Geetanjali Chander
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Room 8047A, Baltimore, MD 21287, USA
| | - Andrew M Cameron
- Division of Liver Transplant Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross 765, Baltimore, MD 21205, USA
| | - Po-Hung Chen
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 429, Baltimore, MD 21287, USA
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Janicsák H, Ungvari GS, Gazdag G. Psychosocial aspects of hematopoietic stem cell transplantation. World J Transplant 2021; 11:263-276. [PMID: 34316451 PMCID: PMC8290998 DOI: 10.5500/wjt.v11.i7.263] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/18/2021] [Accepted: 06/18/2021] [Indexed: 02/06/2023] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) has become a conventional and potentially curative treatment for various hematological diseases. As more sophisticated procedures have been developed and mortality rates have decreased, attention has shifted to the psychosocial challenges associated with transplantation. The psychosocial difficulties accompanying transplantation are addressed in the context of both quality of life (QOL) and psychopathological research. Among the psychiatric comorbidities of HSCT, anxiety, depression, sleep and sexual disorders, delirium and post-traumatic stress disorder are the most studied conditions. Recently, more attention has been focused on the psychosocial burden of caregivers. Devising recommendations for the management of psychiatric symptoms and psychosocial interventions in HSCT sufferers and close relatives is a major concern to consultation–liaison psychiatrists and transplant teams. This review synthesizes and critically evaluates the current literature on the psychosocial aspects of HSCT and appraises the clinical significance of these outcomes. Issues of QOL assessment; psychosocial functioning and QOL in the course of HSCT; impact of graft-versus-host disease and other predictors of QOL and psychosocial functioning; comorbid psychiatric disorders; and interventions to maintain or improve QOL and reduce psychopathology and psychosocial burden on family members are presented.
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Affiliation(s)
- Henrietta Janicsák
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Gabor S Ungvari
- Division of Psychiatry, University of Notre Dame, Fremantle 6009, Australia
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth 6009, Australia
| | - Gábor Gazdag
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
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Chernyak Y, Henderson DR, Teh L, Powell AL, Hinton KE, Hage CA. Characterization of the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) in Lung Transplant Candidates. J Clin Psychol Med Settings 2021; 29:137-149. [PMID: 34043137 DOI: 10.1007/s10880-021-09788-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2021] [Indexed: 01/27/2023]
Abstract
The SIPAT is a standardized measure for pre-transplant psychosocial evaluation. Previous SIPAT studies utilized a relatively small lung transplant sample and only included listed patients. This study characterized the SIPAT in 147 lung transplant candidates to better elucidate its utility. The average score corresponded to a minimally acceptable rating and nearly half of the patients had relative or absolute contraindications. Interstitial Lung Disease (ILD) patients scored more favorably than non-ILD patients (U = 7.69, p < .05). The Total (β = - .05, SE = .018, p < .01), Social Support Subscale (β = - .133, SE = .058, p < .05), and Psychosocial Stability and Psychopathology Subscale (β = - .103, SE = .040, p < .05) significantly predicted listing status. The SIPAT has a unique profile in lung transplant candidates and demonstrated utility for guiding transplant decisions. Future research should examine which lung transplant outcomes are significantly associated with SIPAT scores.
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Affiliation(s)
- Yelena Chernyak
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St, Indianapolis, IN, 46202, USA
| | - Danielle R Henderson
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St, Indianapolis, IN, 46202, USA
| | - Lisa Teh
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, The Bronx, NY, USA
| | - Anna-Leigh Powell
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Kendra E Hinton
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St, Indianapolis, IN, 46202, USA.
| | - Chadi A Hage
- Department of Pulmonary Critical Care and Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
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Deutsch-Link S, Weinberg EM, Bittermann T, McDougal M, Dhariwal A, Jones LS, Weinrieb RM, Banerjee AG, Addis S, Serper M. The Stanford Integrated Psychosocial Assessment for Transplant Is Associated With Outcomes Before and After Liver Transplantation. Liver Transpl 2021; 27:652-667. [PMID: 33320417 PMCID: PMC9531321 DOI: 10.1002/lt.25975] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 12/07/2022]
Abstract
The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) is a standardized psychosocial evaluation tool used in liver transplantation (LT) evaluation. We assessed the impact of the SIPAT score and subdomains on transplant waitlisting decisions and post-LT outcomes including immunosuppression (IS) nonadherence, biopsy-proven rejection, andmortality/graft failure. We conducted a single-center observational cohort study of 1430 patients evaluated for LT. Patients were divided in 2 groups based on a SIPAT cutoff score of <21 or ≥21 (higher SIPAT scores indicate higher psychosocial risk). Regression models assessed relationships between total SIPAT score and domain scores and waitlisting decisions, IS nonadherence, allograft rejection, and death/graft failure. Elevated total SIPAT and SIPAT domain scores were associated not being added to the waitlist (total SIPAT core ≥21 adjusted odds ratio [aOR], 1.78 [95% confidence interval, CI, 1.36-2.33]; readiness score ≥5 aOR, 2.01 [95% CI, 1.36-2.76]; social support score ≥4aOR, 1.50 [95% CI, 1.15-1.94]; psychopathology score ≥7 aOR, 1.45 [95% CI, 1.07-1.94]; lifestyle/substance abuse score ≥12 aOR, 1.72 [95%CI, 1.23-2.39]) and were more likely to experience IS nonadherence as measured by the tacrolimus coefficient of variation (CoV) (total SIPAT score ≥21 aOR, 2.92 [95% CI, 1.69-5.03]; readiness score ≥5 aOR, 3.26 [95% CI, 1.63-6.52]; psychopathology score ≥7 aOR, 1.88 [95% CI, 1.00-3.50]; lifestyle substance abuse score ≥12 aOR, 3.03 [95% CI, 1.56-5.86]). SIPAT readinessscore ≥5 was associated with biopsy-proven allograft rejection (aOR, 2.66; 95% CI, 1.20-5.91). The SIPAT score was independently associated with LT listing decisions and IS nonadherence, and the readiness domain was associated with the risk of allograft rejection. These findings offer insights into higher risk recipients who require additional support before and aftertransplantation.
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Affiliation(s)
- Sasha Deutsch-Link
- Department of Gastroenterology & Hepatology, University of North Carolina–Chapel Hill, Chapel Hill, NC
| | - Ethan M. Weinberg
- Division of Gastroenterology & Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Therese Bittermann
- Division of Gastroenterology & Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Mackenzie McDougal
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - Aniket Dhariwal
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lauren S. Jones
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA
| | - Robert M. Weinrieb
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Arpita G. Banerjee
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Senayish Addis
- Division of Gastroenterology & Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Marina Serper
- Division of Gastroenterology & Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA,Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Abstract
PURPOSE OF REVIEW Despite attention to racial disparities in outcomes for heart failure (HF) and other chronic diseases, progress against these inequities has been gradual at best. The disparities of COVID-19 and police brutality have highlighted the pervasiveness of systemic racism in health outcomes. Whether racial bias impacts patient access to advanced HF therapies is unclear. RECENT FINDINGS As documented in other settings, racial bias appears to operate in HF providers' consideration of patients for advanced therapy. Multiple medical and psychosocial elements of the evaluation process are particularly vulnerable to bias. SUMMARY Reducing gaps in access to advanced therapies will require commitments at multiple levels to reduce barriers to healthcare access, standardize clinical operations, research the determinants of patient success and increase diversity among providers and researchers. Progress is achievable but likely requires as disruptive and investment of immense resources as in the battle against COVID-19.
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Affiliation(s)
- Raymond C Givens
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
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García-Alanís M, Toapanta-Yanchapaxi L, Vilatobá M, Cruz-Martínez R, Contreras AG, López-Yáñez S, Flores-García N, Marquéz-Guillén E, García-Juárez I. Psychosocial evaluation for liver transplantation: A brief guide for gastroenterologists. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2021; 86:172-187. [PMID: 33771379 DOI: 10.1016/j.rgmx.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/09/2020] [Accepted: 12/27/2020] [Indexed: 06/12/2023]
Abstract
Liver transplantation is a lifesaving treatment that improves survival and quality of life. The procedure requires adequate transplant candidate selection carried out by a multidisciplinary team. Psychosocial evaluation is a necessary part of recipient selection and its primary aims are to identify problems and psychosocial needs of the patient and his/her family, to improve transplantation outcomes. Different psychosocial conditions are considered risk factors for morbidity and mortality after transplantation. The presence of those factors per se is not an absolute contraindication, thus adequate evaluation promotes equal access to healthcare, improves results, and optimizes resources. The present review provides an overview of and guidelines for the most important psychosocial issues during the pretransplantation phase.
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Affiliation(s)
- M García-Alanís
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México.
| | - L Toapanta-Yanchapaxi
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
| | - M Vilatobá
- Departamento de Trasplantes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
| | - R Cruz-Martínez
- Departamento de Trasplantes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
| | - A G Contreras
- Departamento de Trasplantes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
| | - S López-Yáñez
- Departamento de Trabajo Social, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
| | - N Flores-García
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
| | - E Marquéz-Guillén
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
| | - I García-Juárez
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
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García-Alanís M, Toapanta-Yanchapaxi L, Vilatobá M, Cruz-Martínez R, Contreras A, López-Yáñez S, Flores-García N, Marquéz-Guillén E, García-Juárez I. Psychosocial evaluation for liver transplantation: A brief guide for gastroenterologists. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021. [DOI: 10.1016/j.rgmxen.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Smith PJ, Potter G, Manson M, Martin M, Cendales LC. Psychosocial considerations in the assessment of hand transplant candidates: A single-center experience and brief literature review. Clin Transplant 2021; 35:e14268. [PMID: 33615558 DOI: 10.1111/ctr.14268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/27/2021] [Accepted: 01/31/2021] [Indexed: 11/27/2022]
Abstract
Vascularized composite allograft, including hand transplantation (HT), has gained wider usage as a reconstructive treatment over the past 30 years. HT recipients face unique psychosocial challenges compared to their solid organ and/or bone marrow transplant counterparts. Accordingly, the psychosocial evaluation among HT candidates continues to evolve, leaving a lack of consensus as to the critical psychosocial domains and psychometric testing instruments to help evaluate individuals considering HT. The present manuscript describes the psychosocial evaluation process within the Duke HT program, which been contacted by 80 potential candidates since 2014. The Duke HT evaluation process incorporates a comprehensive psychosocial assessment within domains including personality, cognitive function, mood, behavioral adherence, social support, and substance use history, among others. Our experience underscores the potential utility of collecting thorough psychosocial evaluations, supplemented by psychometric test data, to comprehensively assess potential HT candidates.
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Affiliation(s)
- Patrick J Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
| | - Guy Potter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Maria Manson
- Duke Office of Clinical Research, Duke School of Medicine, Durham, NC, USA
| | - Michael Martin
- Atlanta VA Healthcare System, Mental Health Service Line, Decatur, GA, USA.,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Linda C Cendales
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
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Thisayakorn P, Sakunwetsa D, Tangwongchai S, Jirakran K, Lolak S, Maldonado JR. The Psychosocial Assessment of Transplant Candidates: Internal Consistency, Interrater Reliability, and Content Validity of the Thai Version of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT-Thai Version). Transplant Proc 2021; 53:779-785. [PMID: 33741202 DOI: 10.1016/j.transproceed.2021.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 02/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Standardized pretransplant psychosocial assessment is critically needed in Thailand to optimize medical and psychosocial outcomes after transplantation. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a comprehensive and evidence-based tool that has demonstrated excellent reliability and predictive value in many psychosocial transplant studies. We translated the SIPAT into Thai and explored the validity and reliability of the SIPAT-Thai version among Thai transplant recipients. METHODS We translated the original SIPAT into Thai following the World Health Organization's standard forward-backward translation procedure and then cross-sectionally assessed its validity and reliability in 110 Thai solid organ transplant candidates. The correlation between background data, total, and sectional scoring results of SIPAT-Thai were also analyzed. RESULTS The SIPAT-Thai demonstrated moderate to good reliability, which was represented by internal consistency with a Cronbach α of .751 and interrater reliability with a κ value at 0.767. The index of item-objective congruence value was 0.94, indicating good the content validity. CONCLUSIONS The SIPAT-Thai was systematically translated and shown to have acceptable validity and a moderate to good reliability index. The use of the SIPAT-Thai would provide a standardized, evidence-based, and a more systematic pretransplant psychosocial evaluation process for transplant candidates in Thailand.
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Affiliation(s)
- Paul Thisayakorn
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Dussadee Sakunwetsa
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Ketsupa Jirakran
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sermsak Lolak
- Department of Psychiatry, Virginia Commonwealth University, Inova Fairfax Medical Campus, Fairfax, Virginia
| | - Jose R Maldonado
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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Denhaerynck K, Goldfarb-Rumyantzev AS, Sandhu G, Beckmann S, Huynh-Do U, Binet I, De Geest S. Pre-transplant Social Adaptability Index and clinical outcomes in renal transplantation: The Swiss Transplant Cohort study. Clin Transplant 2021; 35:e14218. [PMID: 33406303 DOI: 10.1111/ctr.14218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 12/25/2020] [Accepted: 12/29/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND The impact of pre-transplant social determinants of health on post-transplant outcomes remains understudied. In the United States, poor clinical outcomes are associated with underprivileged status, as assessed by the Social Adaptability Index (SAI), a composite score of education, employment status, marital status, household income, and substance abuse. Using data from the Swiss Transplant Cohort Study (STCS), we determined the SAI's predictive value regarding two post-transplant outcomes: all-cause mortality and return to dialysis. METHODS Between 2012 and 2018, we included adult renal transplant patients (aged ≥ 18 years) with pre-transplant assessment SAI scores, calculated from a STCS Psychosocial Questionnaire. Time to all-cause mortality and return to dialysis were predicted using Cox regression. RESULTS Of 1238 included patients (mean age: 53.8 ± 13.2 years; 37.9% female; median follow-up time: 4.4 years [IQR: 2.7]), 93 (7.5%) died and 57 (4.6%) returned to dialysis. The SAI's hazard ratio was 0.94 (95%CI: 0.88-1.01; p = .09) for mortality and 0.93 (95%CI: 0.85-1.02; p = .15) for return to dialysis. CONCLUSIONS In contrast to most published studies on social deprivation, analysis of this Swiss sample detected no significant association between SAI score and mortality or return to dialysis.
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Affiliation(s)
- Kris Denhaerynck
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
| | | | - Gurprataap Sandhu
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sonja Beckmann
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland.,Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Uyen Huynh-Do
- Department of Nephrology and Hypertension, University Hospital Inselspital, Bern, Switzerland
| | - Isabelle Binet
- Nephrology and Transplantation Medicine, Cantonal Hospital, St Gallen, Switzerland
| | - Sabina De Geest
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland.,Academic Center of Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium
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Factors Affecting Quality of Life in Liver Transplant Candidates: An Observational Study. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Health-related quality of life (HRQOL) before and after liver transplant (LT) is an important outcome in LT candidates as, in these patients, HRQOL is commonly impaired. However, evidence regarding factors that influence HRQOL in patients with end-stage liver disease is inconclusive. The aim of the present study was to identify factors associated with poor HRQOL. An observational study was conducted over LT candidates. The 36-item Short Form Health Survey (widely used to assess HRQOL) and the Hospital Anxiety and Depression Scale were administered to 211 patients during the pre-transplant assessment. Baseline demographic and clinical data were also collected. Multiple regression analysis was performed to investigate risk factors for poor HRQOL. Female sex (lower B = 7.99 95%C = 0.07–15.92, higher B = 18.09 95%CI = 7.56–28.62), encephalopathy (lower B = −9.45, 95%CI = −14.59–−4.31, higher B = −6.69, 95%CI = −13.13 to −0.25), higher MELD scores (lower B = −1.14, 95%CI = −1.67 to −0.61, higher B = −0.33, 95%CI = −0.65 to −0.12), anxiety (lower B = −3.04 95%C = −4.71 to −1.36, higher B = −1.93 95%CI = −3.39 to −0.47)and depression (lower B = −3.27 95%C = −4.46 to −2.08, higher B = −1.02 95%CI = −1.90 to −0.13) symptoms were associated to poorer HRQOL. Psychosocial interventions should be addressed to liver transplant candidates, especially to women, patients with anxiety, depression or episodes of encephalopathy, in order to prevent the impact that these conditions can have on HRQOL.
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Dew MA, Hollenberger JC, Obregon LL, Hickey GW, Sciortino CM, Lockard KL, Kunz NM, Mathier MA, Ramani RN, Kilic A, McNamara DM, Simon MA, Keebler ME, Kormos RL. The Preimplantation Psychosocial Evaluation and Prediction of Clinical Outcomes During Mechanical Circulatory Support: What Information Is Most Prognostic? Transplantation 2021; 105:608-619. [PMID: 32345866 DOI: 10.1097/tp.0000000000003287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Psychosocial evaluations are required for long-term mechanical circulatory support (MCS) candidates, no matter whether MCS will be destination therapy (DT) or a bridge to heart transplantation. Although guidelines specify psychosocial contraindications to MCS, there is no comprehensive examination of which psychosocial evaluation domains are most prognostic for clinical outcomes. We evaluated whether overall psychosocial risk, determined across all psychosocial domains, predicted outcomes, and which specific domains appeared responsible for any effects. METHODS A single-site retrospective analysis was performed for adults receiving MCS between April 2004 and December 2017. Using an established rating system, we coded psychosocial evaluations to identify patients at low, moderate, or high overall risk. We similarly determined risk within each of 10 individual psychosocial domains. Multivariable analyses evaluated whether psychosocial risk predicted clinical decisions about MCS use (DT versus bridge), and postimplantation mortality, transplantation, rehospitalization, MCS pump exchange, and standardly defined adverse medical events (AEs). RESULTS In 241 MCS recipients, greater overall psychosocial risk increased the likelihood of a DT decision (odds ratio, 1.76; P = 0.017); and postimplantation pump exchange and occurrence of AEs (hazard ratios [HRs] ≥ 1.25; P ≤ 0.042). The individual AEs most strongly predicted were cardiac arrhythmias and device malfunctions (HRs ≥ 1.39; P ≤ 0.032). The specific psychosocial domains predicting at least 1 study outcome were mental health problem severity, poorer medical adherence, and substance use (odds ratios and HRs ≥ 1.32; P ≤ 0.010). CONCLUSIONS The psychosocial evaluation predicts not only clinical decisions about MCS use (DT versus bridge) but important postimplantation outcomes. Strategies to address psychosocial risk factors before or soon after implantation may help to reduce postimplantation clinical risks.
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Affiliation(s)
- Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA
| | - Jennifer C Hollenberger
- Department of Social Work, Grove City College, Grove City, PA
- School of Social Work, Baylor University, Dallas, TX
| | - Laura L Obregon
- Health Care Policy and Management Program, Carnegie Mellon University, Pittsburgh, PA
- Heart and Vascular Institute, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
| | - Gavin W Hickey
- Heart and Vascular Institute, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Christopher M Sciortino
- Heart and Vascular Institute, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Kathleen L Lockard
- Heart and Vascular Institute, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
| | - Nicole M Kunz
- Heart and Vascular Institute, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
| | - Michael A Mathier
- Heart and Vascular Institute, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Ravi N Ramani
- Heart and Vascular Institute, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Arman Kilic
- Heart and Vascular Institute, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Dennis M McNamara
- Heart and Vascular Institute, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Marc A Simon
- Heart and Vascular Institute, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Mary E Keebler
- Heart and Vascular Institute, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Robert L Kormos
- Heart and Vascular Institute, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
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45
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Sandal S, Chen T, Cantarovich M. Evaluation of Transplant Candidates With a History of Nonadherence: An Opinion Piece. Can J Kidney Health Dis 2021; 8:2054358121990137. [PMID: 33598301 PMCID: PMC7863559 DOI: 10.1177/2054358121990137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/03/2021] [Indexed: 12/18/2022] Open
Affiliation(s)
- Shaifali Sandal
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Tianyan Chen
- Division of Hepatology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Marcelo Cantarovich
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
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46
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KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation. Transplantation 2021; 104:S11-S103. [PMID: 32301874 DOI: 10.1097/tp.0000000000003136] [Citation(s) in RCA: 264] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The 2020 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation is intended to assist health care professionals worldwide who evaluate and manage potential candidates for deceased or living donor kidney transplantation. This guideline addresses general candidacy issues such as access to transplantation, patient demographic and health status factors, and immunological and psychosocial assessment. The roles of various risk factors and comorbid conditions governing an individual's suitability for transplantation such as adherence, tobacco use, diabetes, obesity, perioperative issues, causes of kidney failure, infections, malignancy, pulmonary disease, cardiac and peripheral arterial disease, neurologic disease, gastrointestinal and liver disease, hematologic disease, and bone and mineral disorder are also addressed. This guideline provides recommendations for evaluation of individual aspects of a candidate's profile such that each risk factor and comorbidity are considered separately. The goal is to assist the clinical team to assimilate all data relevant to an individual, consider this within their local health context, and make an overall judgment on candidacy for transplantation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach. Guideline recommendations are primarily based on systematic reviews of relevant studies and our assessment of the quality of that evidence, and the strengths of recommendations are provided. Limitations of the evidence are discussed with differences from previous guidelines noted and suggestions for future research are also provided.
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47
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Hause J, Rice JP. Transplants for Acute Alcoholic Hepatitis: Controversies and Early Successes. Clin Liver Dis 2021; 25:229-252. [PMID: 33978581 DOI: 10.1016/j.cld.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Liver transplant for severe alcohol-associated hepatitis remains a controversial practice despite evidence for a substantial survival benefit compared with medical therapy and posttransplant alcohol relapse rates comparable with previously published studies in alcohol-associated cirrhosis. The controversy stems in part from concern regarding patient selection practices, lack of long-term follow-up data, and the potential negative public perception of the practice affecting organ donation. Despite these concerns, it seems that early liver transplant for alcohol-associated hepatitis is increasingly being offered to selected patients across the United States and the world.
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Affiliation(s)
- Jessica Hause
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 4th Floor MFCB, 1685 Highland Avenue, Madison, WI 53705, USA
| | - John P Rice
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 4th Floor MFCB, 1685 Highland Avenue, Madison, WI 53705, USA.
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Nöhre M, de Zwaan M, Bauer-Hohmann M, Ius F, Valtin C, Gottlieb J. The Transplant Evaluation Rating Scale Predicts Clinical Outcomes 1 Year After Lung Transplantation: A Prospective Longitudinal Study. Front Psychiatry 2021; 12:704319. [PMID: 34512417 PMCID: PMC8426579 DOI: 10.3389/fpsyt.2021.704319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/22/2021] [Indexed: 01/24/2023] Open
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 transplantation Conclusions: 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.
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Affiliation(s)
- Mariel Nöhre
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany.,Member of the German Center for Lung Research (DZL), Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany.,Member of the German Center for Lung Research (DZL), Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
| | - Maximilian Bauer-Hohmann
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Fabio Ius
- Member of the German Center for Lung Research (DZL), Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany.,Department of Cardiac, Thoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christina Valtin
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Jens Gottlieb
- Member of the German Center for Lung Research (DZL), Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
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49
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Shokri T, Saadi R, Wang W, Reddy L, Ducic Y. Facial Transplantation: Complications, Outcomes, and Long-Term Management Strategies. Semin Plast Surg 2020; 34:245-253. [PMID: 33380909 DOI: 10.1055/s-0040-1721760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Within the past two decades, vascularized facial composite allotransplantation has evolved into a viable option in the reconstructive surgeons' armamentarium for patients with extensive facial disfigurements. As it has expanded the frontiers of microsurgical reconstructive techniques, facial transplantation has come to garner widespread interest within both the medical community and the general public. The procedure has established itself as an amalgamation of the forefronts of reconstructive microsurgery, immunology, and transplantation science. Therein too lies its complexity as multifaceted scientific developments are met with ethical and social issues. Both patients and physicians are faced with the everlasting challenges of immunosuppression regimens and their inherent complications, long-term aesthetic and functional considerations, the role of revision procedures, and the inevitable psychosocial implications. This article reflects on the medical and surgical advancements in facial transplantation surgery and highlights anticipated future challenges. It aims to encourage discussion regarding anticipated barriers to current practice and suggest future directions as we transition into the next phase of facial allograft transplantation.
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Affiliation(s)
- Tom Shokri
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Robert Saadi
- Department of Otolaryngology - Head & Neck Surgery, Penn State Health, Hershey, Pennsylvania
| | - Weitao Wang
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Likith Reddy
- Department of Oral and Maxillofacial Surgery, Texas A&M College of Dentistry, Dallas, Texas
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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50
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Standardized Semistructured Psychosocial Evaluation Before Stem Cell Transplantation Predicts Delirium After Transplant. J Acad Consult Liaison Psychiatry 2020; 62:440-444. [PMID: 34219657 DOI: 10.1016/j.jaclp.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Delirium affects many patients undergoing stem cell transplantation (SCT). Delirium is treatable, but prevention is a better goal, making it desirable to identify patients at heightened risk for delirium. A standardized pretransplant psychosocial assessment rating scale, the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), has been demonstrated to predict outcomes in solid organ transplant recipients and nonadherence in patients with SCT. OBJECTIVES In this study, we aimed to evaluate the association of SIPAT score and post-SCT incident delirium. METHODS We retrospectively reviewed records of SCT recipients who had SIPAT evaluations before SCT, for indications of delirium in the 6 months after transplant. We tested the association between SIPAT score and delirium by logistic regression, controlling for relevant covariates such as transplant type (allogeneic vs autologous). RESULTS Of 85 patients (median age of 49 years, range 18-74), 56 (66%) were men, and 43 (50.5%) were autologous SCT recipients. The median pretransplant SIPAT score was 8, range 0-40. There were 15 cases (17.6%) of delirium in the 6 months following transplant. In univariate analyses, transplant type was significantly associated with incident delirium. In multivariate analyses, SIPAT score was significantly associated with incident delirium (odds ratio, 1.090; P = 0.021). CONCLUSIONS Psychosocial risk as quantified by the SIPAT is associated with development of delirium in SCT recipients. This scale can therefore be integrated into medical risk models to anticipate which patients are at higher risk for delirium in their hospital course, enabling preventative measures tailored to the needs of the individual patient.
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