Michael Jeanette1, Aarushi Bansal1, Marta Novak2, Olusegun Famure1, Joseph S. Kim1, Istvan Mucsi1
Mental health and behavioral barriers to completing the pre-transplant evaluation
1 Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada.
2 Department of Psychiatry, University Health Network and University of Toronto, Canada
Background: Mental health (MH) and behavioral problems have been associated with longer time on kidney transplant (KT) waitlists, poorer health-related outcomes, and lower access to transplantation. There is limited literature on specific risk factors that contribute to difficulties in completing the pre-transplant evaluation (PTE) in a Canadian context. We examined the relationship between history of MH problems, non-adherence, and obtaining a final disposition (i.e., transplant suitability, waitlist activation, or living donor transplant).
Methods: This was a single-centre retrospective cohort study of adult patients referred to our KT program from January 1, 2003 to December 31, 2013, and followed up until June 30, 2014. Patients who completed social work assessments (n=1832) were included. Univariable and multivariable associations between the history of MH disorders or non-adherence and time from referral to final disposition were explored using Cox proportional hazards models.
Results: The mean (±SD) age was 49.0 (±13.6) years, 60% of patients were male and 40% had a history of diabetes. Twenty-five percent had a positive history of MH disorders and 18% had a history of non-adherence. Eighty-five percent of patients received a final disposition within four years after referral. Patients with a psychiatric history had a 16% lower (p=0.011) likelihood of PTE completion than those with no psychiatric history. Patients with a history of non-adherence had a 19% lower (p=0.010) likelihood of PTE completion. These differences remained significant after adjusting for socio-demographic characteristics and comorbidity (HR 0.85 [95% CI: 0.74, 0.99] and HR 0.77 [95% CI: 0.65, 0.92] for psychiatric history and non-adherence, respectively).
Conclusions: MH and behavioral problems represent potential barriers to PTE completion. Further studies should investigate whether targeted psychosocial support for MH and behavioural problems can reduce disparities in access to KT.