Psychosocial challenges with transplantation

Psychosocial factors are associated with pre and posttransplant outcomes, but existing recommendations largely rely on small, single-center lung transplant studies or data extrapolated from other solid organ transplants, highlighting the need for an updated comprehensive review.

The 2021 ISHLT consensus statement on lung transplant candidate selection includes psychosocial domains in the evaluation, with few considered absolute contraindications, and instead emphasizes an individualized, holistic approach. Emerging lung-specific evidence supports the continued focus on individual psychosocial risk assessments rather than identification of broad contraindications to transplantation. This is largely due to continued reliance on single-center studies within lung transplantation, use of variable measurement tools for assessing psychosocial domains, and inconsistent associations with outcomes. We identified specific knowledge gaps in need of urgent research, including validation of lung-specific assessment tools, evaluation in larger multicenter and international studies, and development of targeted interventions to address psychosocial domains.

Herein, we review the prior guidelines, synthesize new lung-specific studies, and identify critical knowledge gaps to inform future research directions.