The psychosocial assessment of candidates for transplantation:a prospective cohort study of its association with mortality among kidney transplant candidates

AbstractBackground A psychosocial assessment is an important part of the pre-transplant evaluation. Aims To assess the association between scores on the global Psychosocial Assessment of Candidates Transplant tool and survival in deceased donor kidney transplant candidates. Methods In this prospective longitudinal study, the participants were registered candidates on the waiting list for deceased donor kidney transplants at a transplant center in South Korea. Initially, candidates enrolled in this study in 2016 were divided into high- and low-psychosocial risk cohorts using a Psychosocial Assessment of Candidates Transplant score cutoff of 3 points. In 2022, the mortality rate was compared according to whether the initial Psychosocial Assessment of Candidates Transplant score was < 3 or ≥ 3 points. Results This study included 139 deceased donor kidney transplant candidates, of whom 32 (23.0%) received kidney transplantation. An initial Psychosocial Assessment of Candidates Transplant score < 3 was associated with higher mortality 5 years after being placed on the waiting list (hazard ratio = 12.28,p = 0.017). Current alcohol use at baseline was associated with higher mortality 5 years after being placed on the waiting list (hazard ratio = 12.93,p = 0.032). Conclusions Both a high risk of psychosocial candidacy and current alcohol use were associated with significantly reduced survival 5 years after placement on the waiting list for a deceased donor kidney transplant. The psychosocial status of candidates on the waitlist for kidney transplantation should be regularly screened and systematically managed to improve their psychosocial status and reduce alcohol use to make them more suitable candidates for transplant surgery. A psychosocial intervention should be developed for patients on the waiting list to improve their psychosocial status and promote positive health outcomes after kidney transplantation.