Psychosocial Risk Impacts Mortality in Women After Liver Transplantation

Terry D. Schneekloth, Mario J. Hitschfeld, Tanya M. Petterson, Praveena Narayanan, Shehzad K. Niazi, Sheila G. Jowsey-Gregoire, Nuria J. Thusius, Adriana R. Vasquez, Walter K Kremers, Kymberly D. Watt, Teresa A. Rummans

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3 Scopus citations

Abstract

Background: Liver transplant candidates undergo psychosocial assessment as a component of their pretransplant evaluation. Global psychosocial assessment scales, including the Psychosocial Assessment of Candidates for Transplantation (PACT), capture and quantify these psychiatric and social variables. Objective: Our primary aim was to assess for an association between global PACT score and survival in liver transplant recipients. Methods: This retrospective cohort study examined records of all liver recipients at one U.S. Transplant Center from 2000 to 2012 with outcomes monitoring until 07/01/2016. We investigated for associations between the following variables and mortality: PACT score, age, gender, marital status, race, alcoholic liver disease (ALD), and body mass index (BMI). Statistical methods included Student's t-test, Wilcoxon rank sum test, chi-square, Fisher's exact test, Kaplan–Meier curve, and Cox proportional hazard models. Results: Of 1040 liver recipients, 538 had a documented PACT score. Among these, PACT score was not associated with mortality. In women, a lower PACT score was associated with mortality (p = 0.003) even after adjustments for age, marital status, and BMI. Women with ALD had a 2-fold increased hazard of death (p = 0.012). Increasing age was associated with increased risk of death for the cohort as a whole (p = 0.019) and for men (p = 0.014). In men, being married and BMI were marginally protective (p = 0.10 and p = 0.13, respectively). Conclusions: Transplant psychosocial screening scales, specifically the PACT, identify psychosocial burden and may predict post-transplant outcomes in certain populations. In female liver recipients, lower PACT scores and ALD were associated with a greater risk of post-transplant mortality.

Original languageEnglish (US)
JournalPsychosomatics
DOIs
StateAccepted/In press - Jan 1 2018

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Keywords

  • liver transplantation
  • mortality
  • Outcome
  • PACT
  • PACT score
  • psychosocial
  • Sex differences
  • women

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Applied Psychology
  • Psychiatry and Mental health

Cite this

Schneekloth, T. D., Hitschfeld, M. J., Petterson, T. M., Narayanan, P., Niazi, S. K., Jowsey-Gregoire, S. G., Thusius, N. J., Vasquez, A. R., Kremers, W. K., Watt, K. D., & Rummans, T. A. (Accepted/In press). Psychosocial Risk Impacts Mortality in Women After Liver Transplantation. Psychosomatics. https://doi.org/10.1016/j.psym.2018.06.008