Predictive value of psychosocial assessment for the mortality of patients waiting for liver transplantation

Abstract

Selecting suitable candidates for liver transplantation is the most challenging task of pre-transplant evaluation. In addition to somatic assessment, psychosocial evaluation has been proven important in identifying patients at high risk of potential failure. The Transplant Evaluation Rating Scale (TERS) is a widely used rating instrument for the assessment of psychosocial risk factors before liver transplantation. The aim of this study was to explore the predictive value of TERS for mortality in liver transplant patients before and after transplantation. The medical records of patients referred for psychiatric evaluation before liver transplantation between 2003 -2013 were analysed. Administering TERS was part of the pre-transplant evaluation. The TERS scores of patients who died before and after transplantation were compared with those who survived following transplantation. One hundred and sixteen patients were referred for pre-transplant psychiatric evaluation. Patients with successful liver transplants scored significantly lower on TERS than those who died before transplantation (30.65 ± 6.06 vs. 34.75 ± 8.25, p = .031). Patients who died after transplantation scored significantly better on TERS than those who died before transplantation (28.79 ± 2.81 vs. 34.75 ± 8.25, p = .003). There was no significant difference between the deceased and surviving transplanted patients' TERS scores (28.79 ± 2.81 vs. 31.19 ± 6.66, p = .365). TERS appears to be a suitable rating instrument to help select candidates who have higher chance to survive prior to transplantation but it could not predict post-transplant mortality.

The Utility of a Pre-Transplant Psychosocial Evaluation in Predicting Post-Liver Transplant Outcomes

“…These were chosen as predictor variables since they are routinely assessed across centers to determine candidacy for transplantation and are thought to be predictive of posttransplant outcomes. 2,6 –8…”

“…3,4 Treatment adherence, for example, is rarely assessed in a standardized manner. 5 Research on the validity of these variables in predicting posttransplant outcomes has also been equivocal, 2,6 –8 and several commonly assessed risk factors (alcohol dependence) have not adequately predicted posttransplant outcomes. 8 –10…”

Prediction of survival on the waiting list for heart transplantation and of posttransplant nonadherence—Results of a prospective longitudinal study

“…A pretransplant study by Gazdag et al found the TERS to be a helpful rating tool in the selection of patients with a higher chance of survival. 25 Gazdag's study assessed the predictive value of the TERS for mortality before and after a liver transplant. The pretransplant survival and the days outside the hospital were significantly reduced, 25 and patients who died after transplantation scored significantly better on TERS than those who died before transplantation (28.79 ± 2.81 vs 34.75 ± 8.25, P = 0.003), suggesting the quality and strength of the TERS as a psychosocial assessment instrument.…”

The Transplant Evaluation Rating Scale Predicts Clinical Outcomes 1 Year After Lung Transplantation: A Prospective Longitudinal Study

“…Currently, the TERS is the most frequently used instrument (14,15). The TERS has demonstrated efficacy in predicting peri-and post-transplant outcomes in patients receiving heart, lung, and liver transplants, but also bone marrow or stem cell transplantation as well as left ventricular assist device implantation (15)(16)(17)(18)(19)(20). In previous studies of our group in patients prior to lung transplantation, we evaluated the level of psychosocial functioning using the TERS and validated the TERS and its subscales specifically in patients awaiting lung transplantation (21).…”