An assessment of psychiatric needs pre-and postmultivisceral transplant
Recommended Citation
Fleagle E, Bryce K, Collins K, Jafri SM, Muszkat Y, Yoshida A, Rizzari M, Beltran N, Abouljoud M, and Nagai S. An assessment of psychiatric needs pre-and postmultivisceral transplant. Transplantation 2019; 103(7):S30.
Document Type
Conference Proceeding
Publication Date
10-2019
Publication Title
Transplantation
Abstract
Introduction: As intestinal transplant becomes a more viable treatment option, there has been increased interest in quality of life and other psychosocial metrics. Systematic review suggests that quality of life improves post-transplant. However, there is limited data regarding psychosocial issues present at initial evaluation and post-transplant. Given that psychiatric issues are associated with increased mortality in solid organ transplant, this study aims to highlight psychosocial patterns that are present at initial evaluation and post-transplant. Methods: This study was a retrospective chart review of 28 patients who received intestinal transplants between 8/3/10-1/3/17 at an academic hospital in the United States. Psychosocial variables from encounters with health psychology senior staff and trainees were extracted. Descriptive data were evaluated from pre and post-transplant encounters. Results: Pre-transplant, the most common initial diagnosis was adjustment disorder (68%) with more significant pathology occurring in the remaining patients. 3/28 patients had comorbid substance use issues. 12/28 patients were on psychotropic medications during initial evaluation with 50% of those on multiple medications. Figure 1 describes data from initial psychological assessment. Of those eventually transplanted, 8 required further intervention prior to psychosocial clearance. Among the 28 patients, psychology was consulted an average of 2.71 times. Of those that required follow-up, there was an average of 8.25 follow-ups. Most common reasons for consult were; depression, pain, anxiety, eating related issues, mental status concerns, or other. Of the 28 patients, 19 had post-transplant psychiatric diagnoses. Although adjustment disorders were the most prevalent (8/19), more significant pathology was found in remaining patients including opioid abuse (4/19), PTSD (3/19), and pain disorders (3/19). Conclusion: Present analysis suggests that many pre-transplant patients have significant psychopathology. Post-transplant a number of psychosocial issues persist and can emerge on an inpatient and outpatient basis. Development of behavioral health protocols for the most common consultations will be a valuable clinical service. These interventions may improve psychosocial outcomes, decrease patient noncompliance and reduce disease burden and cost. Future prospective studies, extending period of follow up, and assessing a wider range of predictors and outcomes are needed. (Figure Preseted).
Volume
103
Issue
7
First Page
S30
