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Psychosocial Assessment of Candidates for Transplantation (PACT) Score Identifies High Risk Patients in Pediatric Renal Transplantation.

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Date
2019-01
Authors
Freischlag, Kyle W
Chen, Vivian
Nagaraj, Shashi K
Chua, Annabelle N
Chen, Dongfeng
Wigfall, Delbert R
Foreman, John W
Gbadegesin, Rasheed
Vikraman, Deepak
Chambers, Eileen T
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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.
Type
Journal article
Subject
adherence
kidney
pediatrics
psychosocial factors
renal transplantation
Permalink
https://hdl.handle.net/10161/19113
Published Version (Please cite this version)
10.3389/fped.2019.00102
Publication 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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Scholars@Duke

Chambers

Eileen Tsai Chambers

Associate Professor of Pediatrics
Chen

Dongfeng Chen

Associate Professor in Pathology
Chua

Annabelle Nancy Chua

Associate Professor of Pediatrics
Foreman

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.
Gbadegesin

Rasheed Adebayo Gbadegesin

Wilburt C. Davison Distinguished Professor
Molecular genetics of glomerular disease Genetic risk factors for childhood onset idiopathic nephrotic syndrome
Nagaraj

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,
Wigfall

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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