Pretransplant Predictors of Posttransplant Adherence and Clinical Outcome: An Evidence Base for Pretransplant Psychosocial Screening
Pretransplant Predictors of Posttransplant Adherence and Clinical Outcome: An Evidence Base for Pretransplant Psychosocial Screening
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DOI：
10.1097/tp.0b013e3181a440ae
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发表时间：
2009-05-27
期刊：
影响因子：
6.2
通讯作者：
De Geest, Sabina
中科院分区：
文献类型：
--
作者：
Dobbels, Fabienne;Vanhaecke, Johan;De Geest, Sabina
介绍。人们越来越认识到移植前 (TX) 心理社会因素可以预测 TX 后的结果，但前瞻性证据却很少。我们研究了哪些 TX 前心理社会因素可预测 TX 后免疫抑制 (NA) 不依从性以及心脏、肝脏和肺 TX 的临床结果。方法论。我们对 141 名患者（28 名心脏患者、61 名肝脏患者和 52 名肺患者）从 TX 前至 TX 后一年进行了前瞻性随访。多变量分析确定哪些 TX 前因素（即焦虑、抑郁、人格特质、社会支持、药物依从性和吸烟状况）可预测 TX 后不良结局（即 NA、晚期急性排斥反应、移植物丢失和资源利用），并控制不良结局的医学预测因素。结果。 TX 前自我报告的药物不依从性（比值比 [OR]=7.9）、接受的社会支持较低（OR=0.9）、受教育程度较高（OR=2.7）和较低的“尽责性”（OR=0.8）是 TX 后 NA 的独立预测因素。不稳定的关系会导致移植物丧失（OR=4.9）。 TX 前用药 NA 是晚期急性排斥反应存在的唯一预测因子 (OR=4.4)。没有发现其他不良结果的 TX 前预测因子。结论。这是第一项前瞻性研究，表明选定的 TX 前心理社会因素可预测 TX 后 NA 和不良临床结果，这意味着 TX 前筛查除了传统医学标准外还应包括这组因素。
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 I 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.