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Psychosocial Evaluation for Lung Transplantation: an Empirically Informed Update

  • Thoracic Transplantation (J Patel and A Martin Holm, Section Editors)
  • Published:
Current Transplantation Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review summarizes the pre-surgical psychosocial evaluation for lung transplant (LT), positioned within an evidence-based practice framework and a biopsychosocial model of phenotypes of risk and resilience. We incorporate updated research pertinent to LT published since the landmark 2018 multi-society consensus document on psychosocial evaluations for cardiothoracic transplant.

Recent Findings

The conceptualization and recommendations generated from the psychosocial pre-LT evaluation should be based on current evidence and may be enhanced by incorporating biopsychosocial phenotypes of risk and resilience; interventions may target modifiable risks to improve candidacy. Broad evaluation domains with potential to differentially affect outcomes for LT are psychological, behavioral, cognitive, and social/environmental.

Summary

The psychosocial evaluation is an important component of the multidisciplinary LT candidacy evaluation and may identify areas for optimization prior to LT; psychosocial data should not be treated the same as laboratory-based data in candidacy decision-making, requiring additional context and nuance. Future research should focus on continued examination of psychosocial risk factors including phenotypes and mediators/moderators of risk for LT.

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Data Availability

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Notes

  1. Pack-year cessation index (PCI) = pack years [packs smoked / day multiplied by years smoking] divided by the cessation period before LT in months.

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Authors and Affiliations

  1. Division of Bio-behavioral Medicine, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), 67 President Street, MSC 861, Charleston, SC, 29425, USA

    Lillian M. Christon

  2. Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, USA

    Patrick J. Smith

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Appendix

Appendix

PubMed search inclusion/exclusion criteria and search terms

Inclusion Criteria

  1. 1.

    Peer-reviewed articles on PubMed

  2. 2.

    Articles published in English

  3. 3.

    Original research or reviews focusing on role of pre-transplant psychosocial factors, psychiatric disorders, etc. (from domains of Dew et al. [2018] guidelines) on post-transplant outcomes (whether appropriate should be clear from the abstract)

  4. 4.

    Original research or review articles focused on lung transplant (or heart-lung transplant for advanced lung disease).

    a. Studies with qualitative research designs or intervention studies were included if they specifically added to the knowledge-base on pre-transplant psychosocial evaluations

  5. 5.

    Focus on adults (18+ years) only

  6. 6.

    Publication dates since Dew et al. (2018) guidelines: 1/1/2017-3/9/2021

  7. 7.

    Seminal or other relevant articles identified by authors, or other hand-searched references

Exclusion Criteria

  1. 1.

    Children or population < 18 years of age

  2. 2.

    Focus on post-transplant phase exclusively without relevance to pre-transplant or pre-transplant considerations

  3. 3.

    Studies in populations other than lung transplantation (inclusive of heart-lung transplantation for end-stage lung disease)

  4. 4.

    Guidelines or studies in other populations

  5. 5.

    No information on pre-transplant factors or no relevance to pre-transplant considerations

  6. 6.

    No abstract

  7. 7.

    Not in English

  8. 8.

    Studies focused on donor characteristics

  9. 9.

    Duplicate reference listings

Search Terms

Subtopic

Search terms used, by domain (repetition allowable across domains)

Pre-transplant psychosocial evaluations

(((“Lung Transplantation”[Mesh:noexp]) OR (lung transplant*[tiab]) OR (lung graft*[tiab]) OR (lung allograft*[tiab])) AND ((“pre-transplant psychosocial evaluation*”[tiab]) OR (“psychosocial evaluation”[tiab]) OR (“psychosocial screening”[tiab]) OR (“psychological assessment”[tiab]) OR (Interview, Psychological[MESH:noexp]) OR (“psychological evaluation”[tiab]) OR (“Transplant Evaluation Rating Scale”[tiab]) OR (“TERS”[tiab]) OR (“Psychosocial Assessment of Candidates for Transplantation”[tiab]) OR (“PACT”[tiab]) OR (“Stanford Integrated Psychosocial Assessment for Transplantation”[tiab]) OR (“SIPAT”[tiab])))

Treatment adherence and health behaviors

(((“Lung Transplantation”[Mesh:noexp]) OR (lung transplant*[tiab]) OR (lung graft*[tiab]) OR (lung allograft*[tiab])) AND ((adheren*[tiab]) OR (behavior*[tiab]) OR (complian*[tiab]) OR (Patient Compliance[Mesh:noexp]) OR (Treatment Adherence and Compliance[MESH:noexp]) OR (Medication Adherence[MESH:noexp]) OR (medicat*[tiab]) OR (self-manage*[tiab]) OR (self-care[tiab]) OR (health-manage*[tiab])))

Psychiatric/mental health

(((“Lung Transplantation”[Mesh:noexp]) OR (“lung transplant*”[tiab]) OR (“lung graft*”[tiab]) OR (“lung allograft*”[tiab])) AND ((“psych*”[tiab]) OR (psychosocial*[tiab]) OR (mental health[Mesh:noexp])))

Cognitive status and capacity

(((“Lung Transplantation”[Mesh:noexp]) OR (lung transplant*[tiab]) OR (lung graft*[tiab]) OR (lung allograft*[tiab])) AND ((cogniti*[tiab]) OR (neurologic*[tiab]) OR (neurocog*[tiab]) OR (Neurocognitive Disorders[Mesh:noexp])OR (Cognitive Dysfunction[Mesh:noexp])))

Knowledge and understanding of current illness/treatment options

(((“Lung Transplantation”[Mesh:noexp]) OR (lung transplant*[tiab]) OR (lung graft*[tiab]) OR (lung allograft*[tiab])) AND ((“patient knowledge*”[tiab]) OR (“patient understand*”[tiab]) OR (patient decision-mak*[tiab]) OR (patient decision mak*[tiab]) (patient medication knowledge[tiab]) OR (health literacy[tiab]) OR (“patient educat*”[tiab]) OR (Patient Medication Knowledge[MESH:noexp]) OR (health literacy[MESH:noexp]) OR (Patient Education as Topic[MESH])))

Coping with illness

(((“Lung Transplantation”[Mesh:noexp]) OR (lung transplant*[tiab]) OR (lung graft*[tiab]) OR (lung allograft*[tiab])) AND ((Adaptation, Psychological[MESH]) OR (coping[tiab]) OR (cope[tiab]) OR (positive affect[tiab]) OR (Resilience, Psychological[MESH:noexp]) OR (Posttraumatic Growth, Psychological[MESH:noexp])))

Caregiver/social support

(((“Lung Transplantation”[Mesh:noexp]) OR (lung transplant*[tiab]) OR (lung graft*[tiab]) OR (lung allograft*[tiab])) AND ((social support[tiab]) OR (caregiver[tiab]) OR (social support[MeSH:noexp]) OR (Caregivers/psychology[MeSH:noexp]) OR (interpersonal Relations[MeSH:noexp]) OR (spouses[MeSH:noexp]) OR (caregivers[MeSH]) OR (Psychosocial Support Systems[MESH]) OR (family relations[MeSH:noexp])))

Social history

(((“Lung Transplantation”[Mesh:noexp]) OR (lung transplant*[tiab]) OR (lung graft*[tiab]) OR (lung allograft*[tiab])) AND ((demographic[tiab]) OR (travel distance[tiab]) OR (financ*[tiab]) OR (Socioeconomic Factors[MESH]) OR (“socioeconomic status”[tiab]) OR (religion[MESH]) OR (Educational Status[MESH]) OR (“educational attainment”[tiab]) OR (Literacy[MESH]) OR (Employment[MESH]) OR (marital status[MESH]) OR (“marital status”[tiab]) OR (insurance coverage[MESH]) OR (adverse childhood experiences[MESH]) OR (“adverse childhood experience*”[tiab]) OR (Psychological Trauma[MESH])))

Tobacco (including passive exposure)

(((“Lung Transplantation”[Mesh:noexp]) OR (lung transplant*[tiab]) OR (lung graft*[tiab]) OR (lung allograft*[tiab])) AND ((tobacco[title]) OR (Tobacco Smoking[MeSH Terms]) OR (Tobacco Use Disorder[MeSH Terms]) OR (Tobacco Smoking[MeSH Terms]) OR (smok*[title]) OR (Smoking/adverse effects*[MeSH Terms]) OR (cigarette*[tiab]) OR (E-cigarette*[tiab]) OR (“vaping”[tiab]) OR (“electronic cigarette”[tiab]) OR (Smoking/epidemiology[MeSH Terms]) OR (“passive exposure”[tiab]) OR (“passive smoke exposure”[tiab]) OR (Tobacco Smoke Pollution[MeSH Terms]) OR (“EVALI”[tiab])))

Alcohol

(((“Lung Transplantation”[Mesh:noexp]) OR (lung transplant*[tiab]) OR (lung graft*[tiab]) OR (lung allograft*[tiab])) AND ((alcohol[tiab]) OR (“binge drinking”[tiab]) OR (Alcohol abstinen*[tiab]) OR (alcohol abstinence[MESH]) OR (Alcohol Drinking/trends[MeSH]) OR (alcoholism[MESH]) OR (Alcohol Drinking/psychology[MeSH]) OR (Alcohol-Induced Disorders[MeSH]) OR (Alcohol-Related Disorders[MeSH]) OR (Alcohol Drinking[MeSH Terms])))

Cannabis

(((“Lung Transplantation”[Mesh:noexp]) OR (lung transplant*[tiab]) OR (lung graft*[tiab]) OR (lung allograft*[tiab])) AND ((marijuana[tiab]) OR (cannabi*[tiab]) OR (THC[tiab]) OR (CBD[tiab]) OR (Cannabidiol[MESH]) OR (tetrahydrocannabinol[tiab]) OR (Cannabis[MeSH]) OR (Marijuana Smoking[MeSH]) OR (Marijuana Abuse[MeSH]) OR (Marijuana Use[MeSH]) OR (“EVALI”[tiab])))

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Christon, L.M., Smith, P.J. Psychosocial Evaluation for Lung Transplantation: an Empirically Informed Update. Curr Transpl Rep 9, 76–94 (2022). https://doi.org/10.1007/s40472-022-00360-7

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  • DOI: https://doi.org/10.1007/s40472-022-00360-7

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