Does psychosocial compliance have an impact on long-term outcome after heart transplantation?†

Since patient compliance following organ transplantation is considered a limiting factor for long-term outcome, psychosocial assessment is commonly employed to evaluate suitability for organ transplantation. We analysed the impact of psychosocial characteristics on long-term outcome after heart transplantation in our institution.

The outcomes of 345 patients (82% male, mean age: 56 ± 11 years) who had undergone a heart transplant since 1999 were evaluated taking into consideration major clinical and psychosocial findings. The impact on survival of the psychological habitus, substance abuse, economic status, education level, presence of caregivers and distance from the hospital (Area 1: <100 km, Area 2: ≥100 and <500 km, Area 3: ≥500 km) were considered in an univariate and multivariate analysis.

Univariate analysis showed that only retired patients had an increased risk of mortality. In fact, survival at 1, 5 and 10 years in unemployed versus retired versus employed people was 94 ± 3% vs 91 ± 2% vs 88 ± 3%; 86 ± 5% vs 75 ± 3% vs 80 ± 5%; 72 ± 8% vs 57 ± 5% vs 76 ± 5%, respectively (P = 0.05). Unemployed and employed patients were younger than retired patients. In multivariate analysis, after correction of clinical data, no psychosocial characteristics were found to be risk factors for long-term mortality: psychological problems [hazard ratio (HR) = 0.87; 0.56-1.33]; smoking (HR = 0.96; 0.61-1.54); alcohol abuse (HR = 1.62; 0.73-3.61); absence of caregivers (HR = 0.9; 0.44-1.83); critical economical condition (HR = 1.12; 0.65-1.93); lower school degree (HR = 0.95; 0.60-1.51); unemployment (HR = 1.00; 0.58-1.73) and distance from hospital (HR = 1.12; 0.76-1.98). At the same time, no psychosocial factors were identified as risk factors for coronary allograft vasculopathy, acute rejection and infection.

The psychosocial factors analysed in our study seem to have no impact on patient outcome, and should not preclude candidates from listing for heart transplantation; on the other hand psychosocial assessment should be utilized to identify patients requiring more specific surveillance to obtain the best outcome.