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


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.





Published Version (Please cite this version)


Publication Info

Freischlag, Kyle W, Vivian Chen, Shashi K Nagaraj, Annabelle N Chua, Dongfeng Chen, Delbert R Wigfall, John W Foreman, Rasheed Gbadegesin, et al. (2019). Psychosocial Assessment of Candidates for Transplantation (PACT) Score Identifies High Risk Patients in Pediatric Renal Transplantation. Frontiers in pediatrics, 7(MAR). p. 102. 10.3389/fped.2019.00102 Retrieved from

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.



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,


Annabelle Nancy Chua

Associate Professor of Pediatrics

Dongfeng Chen

Associate Professor in Pathology

Delbert Raye Wigfall

Professor Emeritus 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.


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


Eileen Tsai Chambers

Associate Professor of Pediatrics

Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.