The Utility of a Pre-Transplant Psychosocial Evaluation in Predicting Post-Liver Transplant Outcomes.
The Utility of a Pre-Transplant Psychosocial Evaluation in Predicting Post-Liver Transplant Outcomes.
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移植前心理社会评估在预测肝移植后结局中的作用。
DOI：
10.1177/1526924820978605
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Annunziato RA
中科院分区：
文献类型：
--
作者：
Becker JH;Shemesh E;Shenoy A;Posillico A;Knight CS;Kim SK;Florman SS;Schiano T;Annunziato RA
没有足够的证据表明移植前心理社会评估预测移植后结果的能力。虽然标准化评估是为了提高预测有效性而开发的，但尚不清楚它们的风险分数是否会产生预测结果。我们调查了斯坦福大学移植心理社会综合评估(SIPAT)，这是一种评估这些评估的尺度方法，是否会比标准的心理社会评估更好地预测。在这项回顾性研究中，分析了182例成年肝移植受者的病历，他们在移植后至少一年内服用了他克莫司作为免疫抑制药物。回归分析预测了移植后1年至数据收集时间的相关结果，包括免疫抑制药未粘连和经活检证实的排斥反应。用药物水平变异性指数(MLVI)确定药物不依从性。大约49%的患者有MLVI>；2.5，提示不坚持，15%的患者经历了排斥反应。使用连续评分(P=.70)或二值化评分，高于或低于>；2.5(P=.14)或拒绝(P=0.87)，SIPAT总分都不能预测依从性。与标准评估相比，使用SIPAT阈值(总分和69分)既不能预测依从性(p=.16)，也不能更好地预测持续依从性分数(P=.45)、MLVI>；2.5(P=.42)或排斥(P=0.49)。我们的发现表明，SIPAT无法预测该人群中最重要的两种结果，免疫抑制药物的依从性和排斥性。研究工作应尝试评估使用心理社会评估的最佳方式。
There is insufficient evidence about the ability of pretransplant psychosocial evaluations to predict posttransplant outcomes. While standardized assessments were developed to increase predictive validity, it is unclear whether the risk scores they yield predict outcomes. We investigated if the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), a scaling approach to those assessments, would have been a superior predictor than the standard psychosocial evaluation. In this retrospective study, medical records of 182 adult liver transplant recipients who were at least 1 year posttransplant and prescribed tacrolimus for immunosuppression were analyzed. Regression analyses predicted outcomes of interest, including immunosuppressant nonadherence and biopsy-proven rejection, obtained 1-year posttransplant to time of data collection. Nonadherence was determined using the medication level variability index (MLVI). Approximately 49% of patients had MLVI > 2.5, suggestive of nonadherence, and 15% experienced rejection. SIPAT total score did not predict adherence either using the continuous (P = .70), or dichotimized score, above or below > 2.5 (P = .14), or rejection (P = 0.87). Using a SIPAT threshold (total score > 69) did not predict adherence (p = .16) nor was a superior predictor of the continuous adherence score (P = .45), MLVI > 2.5 (P = .42), or rejection (P = 0.49), than the standard evaluation. Our findings suggest that the SIPAT is unable to predict 2 of the most important outcomes in this population, immunosuppressant adherence and rejection. Research efforts should attempt to evaluate the best manner to use psychosocial evaluations.
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影响因子：
4.6
作者：
Supelana, Christina;Annunziato, Rachel A.;Schiano, Thomas D.;Anand, Ravinder;Vaidya, Swapna;Chuang, Kelley;Zack, Yelena;Florman, Sander;Shneider, Benjamin L.;Shemesh, Eyal
通讯作者：
Shemesh, Eyal
斯坦福移植综合社会心理评估： 医疗和社会心理结果的前瞻性研究
影响因子：
3.3
作者：
Maldonado, Jose R.;Sher, Yelizaveta;Standridge, Kim
通讯作者：
Standridge, Kim
DOI：
10.1111/ajt.14276
发表时间：
2017-10
期刊：
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
影响因子：
--
作者：
Shemesh E;Bucuvalas JC;Anand R;Mazariegos GV;Alonso EM;Venick RS;Reyes-Mugica M;Annunziato RA;Shneider BL
通讯作者：
Shneider BL
DOI：
10.1007/s10880-015-9435-6
发表时间：
2015-09-01
影响因子：
2.2
作者：
Kuntz, Kristin;Weinland, Stephan R.;Butt, Zeeshan
通讯作者：
Butt, Zeeshan
影响因子：
2.8
作者：
Bui, Quan M.;Braun, Oscar O.;Adler, Eric
通讯作者：
Adler, Eric