Pretransplant Predictors of Posttransplant Adherence and Clinical Outcome: An Evidence Base for Pretransplant Psychosocial Screening
Top Cited Papers
- 27 May 2009
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Transplantation
- Vol. 87 (10), 1497-1504
- https://doi.org/10.1097/tp.0b013e3181a440ae
Abstract
There is growing awareness, yet scant prospective evidence that pretransplant (TX) psychosocial factors may predict post-TX outcome. We examined which pre-TX psychosocial factors predict post-TX nonadherence with immunosuppression (NA) and clinical outcomes in heart, liver, and lung TX. We prospectively followed 141 patients (28 heart, 61 liver, and 52 lung) from pre-TX until 1 year post-TX. Multivariable analyses determined which pre-TX factors (i.e., anxiety, depression, personality traits, social support, adherence with medication, and smoking status) predict poor post-TX outcome (i.e., NA, late acute rejection, graft loss, and resource utilization), controlling for medical predictors of poor outcome. Pre-TX self-reported medication nonadherence (odds ratio [OR]=7.9), lower received social support (OR=0.9), a higher education (OR=2.7), and lower “conscientiousness” (OR=0.8) were independent predictors of post-TX NA. Not living in a stable relationship predicted graft loss (OR=4.9). Pre-TX medication NA was the only predictor for presence of late acute rejection (OR=4.4). No other pre-TX predictors for poor outcome could be found. This is the first prospective study demonstrating that selected pre-TX psychosocial factors predict post-TX NA and poor clinical outcome, implying that pre-TX screening should include this set of factors in addition to traditional medical criteria.This publication has 46 references indexed in Scilit:
- Prospective Study on Late Consequences of Subclinical Non-Compliance with Immunosuppressive Therapy in Renal Transplant PatientsAmerican Journal of Transplantation, 2004
- Variations in Patients’ Adherence to Medical RecommendationsMedical Care, 2004
- Predicting outcome after liver transplantation: utility of the model for end-stage liver disease and a newly derived discrimination function1Transplantation, 2004
- A prognostic model for predicting waiting-list mortality for a total national cohort of adult heart-transplant candidatesTransplantation, 2003
- A model to predict survival at one month, one year, and five years after liver transplantation based on pretransplant clinical characteristicsLiver Transplantation, 2003
- The natural history of azathioprine compliance after renal transplantationKidney International, 2001
- Health beliefs, personality, and adherence in hemodialysis patients: An interactional perspectiveAnnals of Behavioral Medicine, 1997
- Personality and patient adherence: Correlates of the five-factor model in renal dialysisJournal of Behavioral Medicine, 1995
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987
- The Hospital Anxiety and Depression ScaleActa Psychiatrica Scandinavica, 1983