Psychosocial Assessment of Candidates for Transplantation (PACT) Score Identifies High Risk Patients in Pediatric Renal Transplantation.
Abstract
Background: Currently, there is no standardized approach for determining psychosocial
readiness in pediatric transplantation. We examined the utility of the Psychosocial
Assessment of Candidates for Transplantation (PACT) to identify pediatric kidney transplant
recipients at risk for adverse clinical outcomes. Methods: Kidney transplant patients
<21-years-old transplanted at Duke University Medical Center between 2005 and 2015
underwent psychosocial assessment by a social worker with either PACT or unstructured
interview, which were used to determine transplant candidacy. PACT assessed candidates
on a scale of 0 (poor candidate) to 4 (excellent candidate) in areas of social support,
psychological health, lifestyle factors, and understanding. Demographics and clinical
outcomes were analyzed by presence or absence of PACT and further characterized by
high (≥3) and low (≤2) scores. Results: Of 54 pediatric patients, 25 (46.3%) patients
underwent pre-transplant evaluation utilizing PACT, while 29 (53.7%) were not evaluated
with PACT. Patients assessed with PACT had a significantly lower percentage of acute
rejection (16.0 vs. 55.2%, p = 0.007). After adjusting for HLA mismatch, a pre-transplant
PACT score was persistently associated with lower odds of acute rejection (Odds Ratio
0.119, 95% Confidence Interval 0.027-0.52, p = 0.005). In PACT subsection analysis,
the lack of family availability (OR 0.08, 95% CI 0.01-0.97, p = 0.047) and risk for
psychopathology (OR 0.34, 95% CI 0.13-0.87, p = 0.025) were associated with a low
PACT score and post-transplant non-adherence. Conclusions: Our study highlights the
importance of standardized psychosocial assessments and the potential use of PACT
in risk stratifying pre-transplant candidates.
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https://hdl.handle.net/10161/19113Published Version (Please cite this version)
10.3389/fped.2019.00102Publication Info
Freischlag, Kyle W; Chen, Vivian; Nagaraj, Shashi K; Chua, Annabelle N; Chen, Dongfeng;
Wigfall, Delbert R; ... Chambers, Eileen T (2019). Psychosocial Assessment of Candidates for Transplantation (PACT) Score Identifies
High Risk Patients in Pediatric Renal Transplantation. Frontiers in pediatrics, 7(MAR). pp. 102. 10.3389/fped.2019.00102. Retrieved from https://hdl.handle.net/10161/19113.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Eileen Tsai Chambers
Associate Professor of Pediatrics
Dongfeng Chen
Associate Professor in Pathology
Annabelle Nancy Chua
Associate Professor of Pediatrics
John William Foreman
Consulting Professor in the Department of Pediatrics
Dr. Foreman's research interests center on participating in multicenter clinical trials
investigating new treatments for hypertension and renal disease.
Rasheed Adebayo Gbadegesin
Wilburt C. Davison Distinguished Professor
Molecular genetics of glomerular disease Genetic risk factors for childhood onset
idiopathic nephrotic syndrome
Shashi Kumar Nagaraj
Professor of Pediatrics
Clinical areas of interest are chronic renal failure, dialysis, transplantation, hypertension,
glomerulonephritis, nephrotic syndrome, urinary tract infections, congenital genitourinary
anomalies, lupus nephritis,
Delbert Raye Wigfall
Professor of Pediatrics
My interests are in the diagnosis and treatment of secondary and inflammatory renal
diseases, hypertension and general nephrology. I have been involved specifically in
the treatment of childhood hypertension, infections, glomerulonephritis, and secondary
disease related to sickle cell anemia, and systemic lupus erythematosus. My previous
basic training is in the area of complement mediated injury, immune cell aberrancies,
and transplant rejection.
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