Palliative Care Utilization and Timing for Patients Undergoing Solid Organ Transplantation in a Large Multicenter...

Area of Science:

• Transplant Surgery
• Palliative Care
• Oncology

Background:

• Solid organ transplant recipients experience significant symptom burden and complex decision-making.
• Palliative care (PC) can address these needs, but its integration into transplant programs is limited and its benefits are not well-defined.

Purpose of the Study:

• To investigate the frequency, timing, and impact of palliative care (PC) referrals in solid organ transplant recipients.
• To identify patterns of PC engagement across different transplant types and time points.

Main Methods:

• Retrospective analysis of 12,676 heart, liver, lung, and kidney transplants across three Mayo Clinic sites (2018-2024).
• Classification of PC encounters into pretransplant, peritransplant, and posttransplant categories.
• Correlation of PC timing with patient outcomes, procedural volume, readmissions, and hospital interventions.

Main Results:

• Only 8.3% of transplant recipients engaged with PC, with significant variation by organ and referral timing.
• Earlier PC engagement (pretransplant) was associated with longer survival and more goals-of-care discussions.
• Peritransplant and posttransplant PC referrals were more common in patients with higher morbidity and closer to death.
• Targeted screening for high-risk patients showed reduced short-term readmissions in heart and lung transplant recipients.

Conclusions:

• Palliative care utilization in solid organ transplantation is infrequent and highly variable.
• Referral timing is often linked to patient morbidity and mortality, underscoring the need for proactive integration.
• Prospective validation of screening tools is essential to optimize PC involvement for transplant recipients most likely to benefit.