Psychosocial evaluation of candidates for solid organ transplantation

Pippa Bailey*, Nikhil Vergis, Michael Allison, Amy Riddell, Emma Massey

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

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.

Original languageEnglish
Pages (from-to)E292-E302
JournalTransplantation
Volume105
Issue number12
DOIs
Publication statusPublished - 1 Dec 2021

Bibliographical note

Funding Information:
P.B. is funded by a Wellcome Trust Clinical Research Career Development Fellowship (Reference 214554/Z/18/Z). N.V. is funded by a Wellcome Trust Imperial College Post-Doctoral Post-CCT Fellowship (reference: 294834/Z/16/Z). N.V. also acknowledges support from the Imperial Biomedical Research Centre.

Publisher Copyright:
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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