Journal Article Annotations
2018, 2nd Quarter
Annotations by Paula Zimbrean, MD, FACLP
Also of interest:
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.
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.
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.