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Background: Societal factors that influence wait‐listing for transplantation are complex and poorly understood. Social determinants of health (SDOH) affect rates of and outcomes after transplantation. Methods: This cross‐sectional study investigated the impact of SDOH on additions to state‐level, 2017–2018 kidney and liver wait‐lists. Principal components analysis, starting with 127 variables among 3142 counties, was used to derive novel, comprehensive state‐level composites, designated (1) health/economics and (2) community capital/urbanicity. Stepwise multivariate linear regression with backwards elimination (n = 51; 50 states and DC) tested the effects of these composites, Medicaid expansion, and center density on adult disease burden‐adjusted wait‐list additions. Results: SDOH related to increased community capital/urbanicity were independently associated with wait‐listing (starting models: B =.40, P =.010 Kidney; B =.36, P =.038 Liver) (final models: B =.31, P =.027 Kidney, B =.34, P =.015 Liver). In contrast and surprisingly, no other covariates were associated with wait‐listing (P ≥.122). Conclusions: These results suggest that deficits in community resources are important contributors to disparities in wait‐list access. Our composite SDOH metrics may help identify at‐risk communities, which can be the focus of local and national policy initiatives to improve access to organ transplantation. [ABSTRACT FROM AUTHOR]

Aims and objectives. To evaluate whether gender, age and their interaction affect health-related quality of life and overall health status following kidney transplantation. Background. Some investigators have examined the main effects of gender and/or age on health-related quality of life following kidney transplantation, but the potential interaction effect of these measures on this outcome has not been reported. Design. This was a cross-sectional, single-centre study, based in one US geographic area. Methods. Self-report survey data were provided by adult kidney transplant recipients using the SF-36 Health Survey (SF-36) and a visual analogue scale of overall health. SF-36 physical and mental component summary and individual scales and overall health were measured prospectively at one time point post-transplant. All adult patients were eligible to participate and rolling enrolment was employed. Statistical effects were tested using analysis of covariance (controlling for time post-transplant). Results. Subjects ( n = 138) included 66 women and 72 men. There were no effects of gender, age group, or their interaction on MCS or overall health scores (all p ≥ 0·12). Physical component summary scale data demonstrated: (i) a significant effect of gender ( p = 0·025); (ii) a statistically marginal effect of age group ( p = 0·068); and (iii) a statistically marginal gender by age group interaction effect ( p = 0·066). Women reported poorer scores on the SF-36 physical functioning ( p = 0·049), role physical ( p = 0·014) and bodily pain scales ( p = 0·028). There was an effect of age group on physical functioning ( p = 0·005), with younger patients reporting higher scores. Conclusions. Women report lower scores on several physical measures and may experience a greater reduction with age in physical health-related quality of life than men. Physical functioning declines with age following kidney transplantation. Relevance to clinical practice. Findings may help healthcare professionals to develop gender- and age-specific interventions to optimize health-related quality of life of kidney transplant patients. [ABSTRACT FROM AUTHOR]

Introduction. Due to the scarcity of cadaveric livers, clinical judgment must be used to avoid futile transplants. However, the accuracy of human judgment for predicting outcomes following liver transplantation is unknown. The study aim was to assess expert clinicians' ability to predict graft survival and to compare their performance to published survival models. Materials and methods. Pre-transplant case summaries were prepared based on 16 actual, randomly selected liver transplants. Clinicians specializing in the care of liver transplant patients were invited to assess the likelihood of 90-day graft survival for each case using (1) a 4-point Likert scale ranging from poor to excellent, and (2) a visual analog scale denoting the probability of survival. Four published models were also used to predict survival for the 16 cases. Results. Completed instruments were received from 50 clinicians. Prognostic estimates on the two scales were highly correlated (median r=0.88). Individual clinicians' predictive ability was 0.61±0.13, by area under the receiver operating characteristic curve. The performance of published models was MELD 0.59, Desai 0.66, Ghobrial 0.61, and Thuluvath 0.45. For three cases, clinicians consistently overestimated the probability of survival (87±10%, 89±9%, 86±9%); these patients had early graft failures caused by postoperative complications. Discussion. Clinicians varied in their ability to predict survival for a set of pre-transplant scenarios, but performed similarly to published models. When clinicians overestimated the chance of transplant success, either sepsis or hepatic artery thrombosis was involved; such events may be hard to predict before surgery. [ABSTRACT FROM AUTHOR]

Objective--To present an overview of methods for incorporating the measurement of health-related quality of life and patient satisfaction into a comprehensive outcomes assessment program in the organ transplantation setting. An introduction to basic psychometric concepts as they relate to survey instrument selection is presented, and the complementary nature of health status instruments and preference-based utility measures is discussed. The role of these concepts and measures in a transplant outcomes assessment and research program and the psychometric evidence for selected instruments are described. Data Sources--Descriptions of specific survey instruments were abstracted from published reports or manuals. Data describing the Vanderbilt Transplant Center Patient Satisfaction Inventory were derived from a single institution transplant outcomes research database. Study Selection and Data Extraction--Previously reported research was selected from the literature to provide brief examples of basic concepts, which are not intended to be a comprehensive review of these topics. Illustrative data from the Vanderbilt program were extracted from a longitudinal database. Data Synthesis-Data and published reports were synthesized for descriptive and illustrative purposes. Conclusions--This review describes various types of health-related quality of life and patient satisfaction outcomes assessment tools and measurement methods; introduces considerations relevant to survey instrument selection and development; and outlines the evolution of and psychometric support for a transplant center-wide outcomes assessment and research program. [ABSTRACT FROM AUTHOR]

Hypothesis Donor, technical, and recipient risk factors cumulatively impact survival and health-related quality of life after liver transplantation. Design Retrospective study. Setting Tertiary care center. Patients A total of 483 adults undergoing primary orthotopic liver transplantation between January 1, 1991, and July 31, 2003. Main Outcome Measures Graft and patient survival, Karnofsky functional performance scores, Medical Outcomes Study Short Form 36 Health Survey scores, and Psychosocial Adjustment to Illness Scale scores as influenced by potential risk factors including donor age, weight, warm ischemia time, cold ischemia time (CIT), sex, United Network for Organ Sharing (UNOS) status (1 or 2A vs 2B or 3), recipient age and disease, bilirubin level, and creatinine level. Results Five-year graft survival was 72% for recipients of donors younger than 60 years and 35% for recipients of donors 60 years and older (P<.001). A CIT of 12 hours or more was associated with shorter 5-year graft survival (71% vs 58%; P = .004). Five-year graft survival for UNOS status 2B or 3 was 71% vs 60% for status 1 or 2A (P = .02). A comparable pattern was seen for patient survival in relation to donor age (P = .003), CIT (P = .005), and urgency status (P = .03). Urgent UNOS status, advanced donor age, and prolonged CIT were independently associated with shorter graft and patient survival (P<.05). Functional performance and health-related quality of life were not affected by donor, recipient, or technical characteristics. Conclusions Combining advanced donor age, urgent status, and prolonged CIT adversely affects graft and patient survival, and the cumulative effects of these risk factors can be modeled to predict posttransplant survival. [ABSTRACT FROM AUTHOR]

Abstract: Background: We sought to determine if disparities in survival and health-related quality of life (HRQOL) occurred after solid organ transplantation at our institution. Methods: Data were extracted from a database including information regarding transplants that took place from 1990 to 2002. The HRQOL was assessed in patients by using the Karnofsky functional performance (FP) index and the Medical Outcomes Study Short Form 36 (SF-36) questionnaire. Results: Data were collected on recipients of liver (n = 413), heart (n = 299), kidney (n = 892), and lung (n = 156). Blacks represented a minority of recipients: liver 7%, heart 8%, kidney 23%, and lung 6%. There were no statistically significant differences in patient survival between blacks and whites. Graft survival differed in kidney only with a 5-year survival: 72% for blacks versus 79% for whites (P &#60;0.001). The FP and HRQOL improved (P &#60;0.05) after transplantation in both groups. There were no differences on measures of the FP or HRQOL. Conclusions: Blacks had comparable survival and improvement in FP and HRQOL in comparison with whites. [Copyright &y& Elsevier]

Feurer ID, Moore DE, Speroff T, Liu H, Payne J, Harrison C, Pinson CW. Refining a health-related quality of life assessment strategy for solid organ transplant patients. Clin Transplant 2004: 18 (Suppl. 12): 39–45. © Blackwell Munksgaard, 2004 The psychometric properties of generic health-related quality of life (HRQOL) assessment instruments were evaluated to identify a reliable, valid, and non-redundant battery to measure longitudinal outcomes in organ transplant patients. Objective functional performance and subjective HRQOL were assessed in 371 solid organ (liver, heart, kidney, lung) transplant patients using the Karnofsky scale, the SF-36® Health Survey (SF-36®), and Psychosocial Adjustment to Illness Scale (PAIS). The surveys' internal-consistency reliability, criterion-related validity, and redundancy were tested. The SF-36® mental (MCS) and physical components (PCS), and PAIS summary scales were internally consistent (all α ≥ 0.83). Four out of seven PAIS scales (vocational, domestic, sexual, social) were collectively associated with the PCS ( R = 0.65, P < 0.001), as was functional performance ( r = 0.52, P < 0.001). Three PAIS scales (family, social, psychological distress) were associated with the MCS ( R = 0.72, P < 0.001). Only the PAIS healthcare orientation (satisfaction) scale was not associated with the SF-36®. The relationship between functional performance and the PCS is stronger ( r = 0.52, P < 0.001) than with the MCS ( r = 0.25, P < 0.001) and the PAIS global score ( r = 0.37, P < 0.001). The SF-36® and PAIS are internally consistent and exhibit divergent criterion-related validity but, with the exception of the PAIS healthcare orientation scale, are statistically redundant. The advantages of the SF-36® include wider use, more norms, and a lesser response burden. A transplant-specific patient satisfaction inventory was indicated and was developed. [ABSTRACT FROM AUTHOR]

: BackgroundThe current study was undertaken to identify factors specific to kidney transplantation that are associated with posttransplant functional performance (FP) and health-related quality of life (HRQOL).: MethodsKarnofsky FP status was assessed longitudinally in 86 adult kidney transplant recipients. Patients reported HRQOL using the Short Form-36 (SF-36) health survey and the Psychosocial Adjustment to Illness Scale (PAIS).: ResultsFP improved (P <0.001) after kidney transplantation (from 75 ± 1 to 77 ± 1, 81 ± 1, and 82 ± 1 at 0, 3, 6, and 12 months, respectively). Patients receiving organs from living donors showed continued improvement through posttransplant year 1 while those receiving cadaveric organs stabilized at month 6 (simple interaction contrast, year 1 versus pretransplant; P <0.05). Patients receiving dialysis therapy for 6 months or more prior to transplantation demonstrated lower SF-36 posttransplant physical component scores in comparison with patients who were transplanted preemptively (38 ± 1 versus 45 ± 2, P <0.05). Path analysis demonstrated the positive direct effect of time on FP with kidney transplantation (β = 0.23, P <0.05), and the negative direct effects on FP of diabetes (β = −0.22) and cadaveric organs (β = −0.22, both P <0.05). In turn, FP had a positive direct effect on HRQOL (β = 0.40, P <0.001).: ConclusionsOverall improvement in FP is attenuated 1 year after kidney transplantation in recipients of organs from cadaveric donors. The positive effect of time after transplantation, and the negative effects of cadaveric organs and diabetes on posttransplant HRQOL, are indirect and are mediated by the direct effects of these variables on posttransplant FP. [Copyright &y& Elsevier]