Journal Article Annotations
2016, 3rd Quarter
Annotations by Paula Zimbrean, MD, FAPM
The finding: Adding measures of cognitive function and depressive symptoms to the Fried frailty phenotype improved the predictive value of frailty in regards to post-transplant mortality.
Strength and weaknesses: This was a prospective cohort study of 169 patients evaluated at a single heart transplant center. Forty six received a heart transplant, 32 received VADs. It is remarkable that no patients were lost for follow up. The analysis included other factors which can predict mortality. The study carries the limitation inherent to most research in transplant patients due to the selection bias prior to listing. In addition, there is the possibility of the survivor bias (many frail patients did not survive to receive a HT or VAD). The study lacked power to determine the effect of frailty upon survival.
Relevance: This study suggests the importance of depression and cognitive function for the overall concept of frailty as a multidimensional syndrome. For transplant patients, the study emphasizes the possible effect of pre-transplant cognitive function upon posttransplant mortality.
The finding: Thirty one percent of liver donors report significant physical and financial difficulties with only modest psychological benefit after liver donation. Despite this finding, 90% feel positive about donation.
Strength and weaknesses: This study reports on data collected by the A2ALL-2 consortium consisting of nine US and Canadian transplant centers. 517 donors were interview with a response rate of 66%. The main limitation of the study is due to its cross-sectional design, as the psycho-social well being can vary significantly over time. In addition, the measures used to assess the psycho-social wellbeing were not specific to organ donation.
Relevance: This study offers important information about the overall long-term psychosocial concerns of living liver donors. It is likely that the findings of this study will be incorporated in the overall education and informed consent process for liver donors.
The finding: Patients with low score on the Psychosocial Assessment of Candidates for Transplant (PACT) scale had a greater likelihood of mortality after lung transplantation.
Strength and weaknesses: This study included 110 lung transplant recipients followed over a 12-year time frame. The analysis included adjustments for the most relevant factors influencing mortality (age, type of lung disease and unilateral versus bilateral lung transplant). The limitations of the study consist in the inherent selection bias that occurs with listing for transplantation, lack of PACT score in 16% of the lung transplant recipients and questionable generalizibility since the study included only patients at one transplant center.
Relevance: This study emphasizes the role of psychosocial factors in determining posttransplant mortality in lung transplant recipients.