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

Dew, Mary Amanda; DiMartini, Andrea F.; Dobbels, Fabienne; Grady, Kathleen L.; Jowsey‐Gregoire, Sheila G.; Kaan, Annemarie; Kendall, Kay; Young, Quincy-Robyn; Abbey, Susan; Butt, Zeeshan; Crone, Catherine; Geest, Sabina De; Doligalski, Christina T.; Kugler, Christiane; McDonald, Laurie L.; Ohler, Linda; Painter, Liz; Petty, Michael; Robson, D.; Schlöglhofer, Thomas; Schneekloth, Terry D.; Singer, Jonathan P.; Smith, Patrick J.; Spaderna, Heike; Teuteberg, Jeffrey J.; Yusen, Roger D.; Zimbrean, Paula C.

doi:10.1016/j.healun.2018.03.005

Cited by 141 publications

(118 citation statements)

References 262 publications

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“…Many pulmonologists also indicated that poor medication adherence is a barrier to referral which again may reflect this item being considered an absolute contraindication for transplant by the ISHLT [1]. Pretransplant non-adherence increases risk for nonadherence and mortality post-surgically [13], however perfect adherence to a complex CF treatment regimen consumes nearly 2 h each day [14], making adherence challenging for individuals with CF. Studies on CF patient-level barriers to LTx are limited but past nonadherence has been linked to feelings of inferior worthiness for transplant by patients [15].…”

Section: Barriers To Referralmentioning

confidence: 99%

Lung transplant referral practice patterns: a survey of cystic fibrosis physicians and general pulmonologists

et al. 2020

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Background: Many individuals with cystic fibrosis (CF) die from respiratory failure without referral for lung transplant. Physician practices that may expedite, delay, or preclude referral, are poorly understood. Methods: Two parallel, web-based surveys focusing on lung transplant referral triggers and barriers, as well as prereferral evaluation, were emailed to pulmonologists practicing in the New England region. One questionnaire was sent to CF providers (n = 61), and the second to general pulmonary providers practicing at the same institutions (n = 61). Results: There were 43 (70%) responses to the CF provider survey, and 25 (41%) responses to the general pulmonary ('non-CF') provider survey. Primary reasons for CF providers to refer their patients included: rapidly declining lung function (91%) and a forced expiratory volume in 1 s (FEV 1) below 30% predicted (74%). The greatest barriers to referral for both CF and non-CF providers included active tobacco use (65 and 96%, respectively, would not refer), and active alcohol or other substance use or dependence (63 and 80%). Furthermore, up to 42% of CF providers would potentially delay their referral if triple-combination therapy or other promising new, disease-specific therapy were anticipated. In general, non-CF providers perform a more robust pre-referral medical work-up, while CF providers complete a psychosocial evaluation in higher numbers. Across both groups, communication with lung transplant programs was reported to be inadequate. Conclusions: Physician-level barriers to timely lung transplant referral exist and need to be addressed. Enhanced communication between lung transplant programs and pulmonary providers may reduce these barriers.

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Section: Barriers To Referralmentioning

confidence: 99%

Lung transplant referral practice patterns: a survey of cystic fibrosis physicians and general pulmonologists

et al. 2020

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“…Though inconsistencies in policies are observed across adult transplant programs, there is a general growing consensus across international guidelines and recommendations that active substance abuse is a contraindication for transplantation and that substance use and treatment history should be assessed during transplant evaluations and intervention recommendations should be given . Indeed, the ISHLT’s consensus expert opinion on adult lung transplantation indicates that substance abuse or dependence is an absolute contraindication for transplantation, and evidence of engagement in psychotherapy in addition to blood/urine testing to evince abstinence may be required before transplantation .…”

Section: Introductionmentioning

confidence: 99%

Providers’ perspectives on substance use among solid organ transplant candidates in a pediatric hospital

Christofferson

Burgers

Buchanan

et al. 2020

Pediatric Transplantation

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Introduction: Substance use is prevalent among youth and often leads to impairment in multiple domains. Additionally, substance use may pose adverse health issues posttransplant. Yet, practices related to substance use among pediatric patients who require organ transplant remain inconsistent. In this study, providers were surveyed for their perspectives on substance use among solid organ transplant candidates within a pediatric hospital.Methods: An online survey was administered to providers on the heart, kidney, and liver transplant teams at one tertiary pediatric care center located in the intermountain region of the United States (N = 50, 42% response rate). Providers answered questions about the need for a hospital-wide policy across heart, liver, and kidney transplant teams within this transplant center, timing of substance use evaluation, types of substances eliciting concerns based on organ, and recommended interventions. Data were analyzed using descriptive statistics. Results:Providers felt strongly about the need for a policy to guide recommendations for substance use among transplant candidates. Providers wanted a hospitalwide substance use policy (84%) and a standardized measure for assessing substance use (98%). Respondents (98%) indicated that substance use should be assessed during the pretransplant evaluation. Respondents expressed varied concerns based on substance and organ type, and recommended interventions for patients to cease substance use prior to transplant listing. Conclusions:This study highlights the need for a clear, directive, hospital-wide policy and standardized procedure for evaluating substance use among adolescent solid organ transplant candidates nationally across pediatric transplant centers.

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“…The Committee decides whether a candidate is suitable for transplantation, if it is preferable to wait until certain risk factors have been resolved, or if there are medical or psychosocial issues which exclude a candidate from joining the waiting list. Recently, recommendations on the psychosocial evaluation of candidates for heart and lung transplantation as well as indications and contraindications for lung transplantation have been published . In addition, the listing criteria for heart transplantation were updated by the International Society for Heart and Lung Transplantation (ISHLT) .…”

Section: Introductionmentioning

confidence: 99%

Translation, adaptation, and reliability of the Stanford Integrated Psychosocial Assessment for Transplantation in the Spanish population

López-Lazcano

López‐Pelayo

Lligoña

et al. 2019

Clinical Transplantation

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Background: Psychosocial risk factors influence the course of transplantation. Psychosocial evaluation is an important part of pre-transplantation evaluation processes, yet there are no standardized instruments in Spanish. Objective: To translate, adapt, and test the reliability of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) in organ and cell transplantation patients in the Spanish context. Method: A Spanish version was developed and adapted using WHO's guidelines. The first 30 candidates' SIPAT interviews were recorded and scored by four independent examiners to test the inter-rater reliability. The internal consistency of the SIPAT items was calculated with a sample of 150 heart, liver, and allogeneic haematopoietic stem cell transplant candidates. Evaluations were conducted by SIPAT-trained and transplantation-experienced clinical psychologists and psychiatrists. Results: Stanford Integrated Psychosocial Assessment for Transplantation achieved excellent intra-class correlation reliability coefficients between investigators (ICC = 0.93 for the general score and from 0.77 to 0.94 for domain scores). Good internal consistency was found with Cronbach's alpha of 0.84 (from 0.69-0.71 for domains).

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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

Cited by 141 publications

References 262 publications

Lung transplant referral practice patterns: a survey of cystic fibrosis physicians and general pulmonologists

Lung transplant referral practice patterns: a survey of cystic fibrosis physicians and general pulmonologists

Providers’ perspectives on substance use among solid organ transplant candidates in a pediatric hospital

Translation, adaptation, and reliability of the Stanford Integrated Psychosocial Assessment for Transplantation in the Spanish population

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