Psychosocial Effects on Heart Transplantation Candidate Selection and Postoperative Outcomes

Introduction Heart Transplant (HT) remains the most effective therapy for patients with stage D heart failure (HF). Multiple quantitative parameters are used to define medical risk, and while a general consensus exists regarding medical criterial for transplant listing, substantial heterogeneity is present when assessing psychosocial risks. No consensus exists on how to quantitatively assess psychosocial risk or if quantitative risk stratification may better predict adverse events. We hypothesize that a quantitative psychosocial risk profile can be developed for advanced HF patients, and that this model may predict post-HT complications. Methods We retrospectively reviewed the records of all patients presented to the HT selection committee at the University of Maryland between 2013-2016. Standardized preoperative psychiatric evaluations assigned low, medium, and high risk for: history of psychiatric disorders, adherence to medical therapies, substance abuse history, and strength of support network. Scores were coded using 0 for low, 1 for medium, and 2 for high risk features, then summed to form a cumulative risk score. Two-sample T tests and ANOVA were performed to compare cumulative risk scores to committee decisions and 1-year mortality data including: survival to one year, readmissions, need for hemodialysis, ICU bed, intubation, non-adherence, missed office visits, and tacrolimus trough outside goal. Results A total of 104 patients were studied Committee decisions included: 67 patients accepted, 15 rejected, and 22 deferred for HT, of whom 10 were accepted on representation. Overall 49 patients underwent HT and survived to discharge. Patients accepted on first presentation had an average cumulative risk score of 0.756. Higher risk scores were associated with committee rejection (1.667, p=0.033) and deferment (1.682, p Conclusions Several studies have demonstrated the impact of psychological functioning, medication adherence, and social support on post-HT morbidity and mortality. We developed a score to quantify psychosocial comorbidities which was significantly associated with HT committee decisions. However, there was no association between higher risk scores and 1-year outcomes. Our quantitative assessment of psychosocial risk revealed patients with higher psychosocial comorbidities may be listed for heart transplantation without increased 1-year morbidity and mortality.