Journal Article Annotations
2018, 2nd Quarter

Transplant Psychiatry

Annotations by Paula Zimbrean, MD, FACLP
July 2018

Psychosocial predictors of medication non-adherence in pediatric organ transplantation: a systematic review
Impact of psychiatric comorbidities on outcomes of elderly liver transplant recipients

Also of interest:

Dew MA, DiMartini AF, Dobbels F, et al: The 2018 ISHLT/APM/AST/ICCAC/STSW recommendations for the psychosocial evaluation of adult cardiothoracic transplant candidates and candidates for long-term mechanical circulatory support
J Heart Lung Transplant 2018; 37(7):803-823
Type of study: Expert guideline

This article outlines recommendations for the content and process of the psychosocial evaluation of candidates to heart transplantation, lung transplantation and long-term mechanical circulatory support. These recommendations are the result of collaboration between members of several organizations, including the Academy of Consultation-Liaison Psychiatry.

PUBLICATION #1 — Transplant Psychiatry

Psychosocial predictors of medication non-adherence in pediatric organ transplantation: a systematic review

Killian MO, Schuman DL, Mayersohn GS, Triplett KN

Abstract: Pediatr Transplant 2018; 22(4):e13188

Adherence to immunosuppressant medication is critical to health and quality-of-life outcomes for children who have received a solid organ transplant. Research on the psychological and social predictors of medication adherence is essential to the advancement of pretransplant assessments and transplant psychosocial services. Despite the importance of identifying risk factors, the literature remains limited regarding psychosocial predictors of non-adherence. A systematic search was conducted to identify studies of the psychosocial predictors of post-transplant medication non-adherence in pediatric solid organ transplantation. From 1363 studies identified in searches of empirical literature, a final sample consisted of 54 publications representing 49 unique studies. Findings regarding psychosocial predictors were inconsistent with non-adherence associated largely with adolescence, racial/ethnic minority status, and presence of mental health issues. Familial predictors of non-adherence problems included single-parent households, lower socioeconomic status, lower family cohesion, presence of family conflict, and poor family communication. Several studies reported an association between non-adherence and social pressures (eg, peer social interaction, wanting to feel normal) among adolescent transplant recipients. While significant methodological and substantive gaps remain in this body of knowledge, this review synthesizes current evidence for assessment for transplant clinicians and researchers.

On PubMed: Pediatr Transplant 2018; 22(4):e13188

Annotation

Type of study: Systematic review

The finding: This study found that the most important predictors for non-adherence in the pediatric organ transplantation population are family-related (single parent household, lower social work in a mixed status, presence of family conflict, poor family communication) or related to social factors (difficulties with social integration). There is no clear data on the importance of mental health issues in predicting difficulties with adherence in this group.

Strength and weaknesses: This is a systematic review that followed PRISMA guidelines. The initial search of medical databases and Google Scholar produced an initial group of 1,534 studies. After systematic exclusion of publications that were not relevant, 48 studies were analyzed with the median sample size of 52 patients. Studies focused primarily on pediatric kidney transplant recipients (n = 20, 40.8%) followed by liver transplant (n = 12, 24.5%) and heart transplant (n = 5, 10.2%). The follow-up period of the patients included in the study was also significant: of the studies reporting a mean time posttransplant, participants were on average 5.48 years posttransplant at the time of data collection

The main weakness of the study consists in the variability of the study designs (measurements, follow-up, population assessed) for the articles analyzed.

Relevance: This is likely the biggest systematic review on this topic published to date. The findings support the approach that mental health problems to not always lead to non-adherence. The results also encourage further research that would explore in more depth the factors contributing to poor adherence to treatment in pediatric transplantation patients.

PUBLICATION #2 — Transplant Psychiatry

Impact of psychiatric comorbidities on outcomes of elderly liver transplant recipients

Niazi SK, Schneekloth TD, Vasquez AR, et al

Abstract: J Psychosom Res 2018 Aug; 111:27-35

OBJECTIVES: This study evaluated the impact of psychiatric comorbidities in liver transplant (LT) recipients aged ≥65 years (elderly) on length of hospital-stay (LOS), death, and a composite outcome of graft loss or death.

METHODS: This retrospective study assessed impact of psychiatric comorbidities in 122 elderly LT recipients and a matched group of 122 LT recipients aged <65 years (younger). Associations were assessed using adjusted multivariable regression models.

RESULTS: Among elderly, median age at LT was 68 years, most were males (62%), white (85%) and 61.7% had a history of any psychiatric diagnosis. Among younger, median age was 55, most were males (67.2%), white (77.5%) and 61.5% had any psychiatric diagnosis. Median LOS was 8 days for both groups. Among elderly, after a median follow-up of 5 years, 25.4% died and 29.5% experienced graft loss or death. History of adjustment disorder, history of depression, past psychiatric medication use, and pain prior to LT were associated with an increased risk of death or the composite graft loss or death. Perioperative use of SSRIs and lack of sleeping medication use were associated with longer LOS. Among aged <65, after median follow-up of 4.7 years, 21 patients (17%) died and 25 (20%) experienced graft loss or death; history of depression, perioperative SSRIs or sleeping medications use was associated with increased mortality and graft-loss or death.

CONCLUSION: Six out of 10 patients among both elderly and younger cohorts had pre-LT psychiatric comorbidities, some of which adversely affected outcomes after LT.

On PubMed: J Psychosom Res 2018 Aug; 111:27-35

Annotation

Type of study: Retrospective case control study

The finding: A majority (over 60%) of liver transplant recipients, both elderly and young, had a psychiatric comorbidity. Some psychiatric factors including prior medication use and a history of depression were associated with increased risk of death after transplantation.

Strength and weaknesses: To our knowledge, this is the first study focusing on the impact of the psychiatric comorbidities upon medical outcomes after liver transplantation in the elderly. The weaknesses of the study are inherent to the retrospective design and to the lack of analysis of medical factors that contribute to the medical outcomes of mortality and death after transplantation.

Relevance: The findings are relevant to the ongoing debate about the optimal age limit for liver transplantation.