Pretransplant predictors of posttransplant adherence and clinical outcome: an evidence base for pretransplant psychosocial screening

Transplantation. 2009 May 27;87(10):1497-504. doi: 10.1097/TP.0b013e3181a440ae.


Introduction: 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.

Methodology: 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.

Results: 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.

Conclusion: 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.

MeSH terms

  • Adult
  • Anxiety / epidemiology
  • Depression / epidemiology
  • Educational Status
  • Female
  • Graft Rejection / psychology
  • Heart Transplantation / psychology
  • Humans
  • Interpersonal Relations*
  • Liver Transplantation / psychology
  • Lung Transplantation / psychology
  • Male
  • Mass Screening
  • Medication Adherence*
  • Middle Aged
  • Multivariate Analysis
  • Patient Compliance*
  • Patient Selection
  • Personality Inventory
  • Personality*
  • Predictive Value of Tests*
  • Preoperative Care / psychology
  • Prospective Studies
  • Psychology*
  • Reoperation / statistics & numerical data
  • Transplantation / psychology*
  • Treatment Outcome*