Transplant Psychiatry

Journal Article Annotations
2018, 2nd Quarter

Transplant Psychiatry

Annotations by Paula Zimbrean, MD, FACLP
July 2018

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

Also of interest:

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


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


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.