Istvan Mucsi1, Aarushi Bansal, Michael Jeannette, Olusegun Famure, Yanhong Li, Marta Novak, S Joseph Kim. 1. 1 Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada. 2 Centre for Mental Health, University Health Network and Department of Psychiatry, University of Toronto, Canada. 3 Institute of Behavioural Sciences, Semmelweis University Budapest, Hungary. 4 Institute of Health Policy, Management and Evaluation, University of Toronto.
Abstract
BACKGROUND: A history of mental health (MH) disorders or nonadherence (NA) may be barriers to completing the work-up (WU) and/or undergoing kidney transplantation (KT) but this has not been well documented. In this work, we analyzed the relationship between a history of MH disorders or NA and the likelihood of completing the WU or undergoing KT. METHODS: Patients referred for KT to the Toronto General Hospital from January 1, 2003, to December 31, 2012, and who completed a social work assessment, were included (n = 1769). The association between the history of MH disorders or NA and the time from referral to WU completion or KT were examined using Cox proportional hazards models. RESULTS: A history of MH disorders or NA was present in 24% and 18%, respectively. Patients with MH disorders had a 17% lower adjusted hazard of completing the WU within 2 years of referral (HR 0.83; 95% confidence interval [95% CI], 0.71-0.97). Similarly, patients with a history of NA had a 21% lower hazard of completing the WU (hazard ratio [HR], 0.79; 95% CI, 0.66-0.94). The adjusted HR for KT was 0.88 (95% CI, 0.74-1.05) and 0.79 (95% CI, 0.64-0.97) for MH disorders and NA, respectively. CONCLUSIONS: These findings suggest that a history of MH disorders or NA is a potential barrier to KT. Whether targeted psychosocial support can improve access to KT for these patients requires further study.
BACKGROUND: A history of mental health (MH) disorders or nonadherence (NA) may be barriers to completing the work-up (WU) and/or undergoing kidney transplantation (KT) but this has not been well documented. In this work, we analyzed the relationship between a history of MH disorders or NA and the likelihood of completing the WU or undergoing KT. METHODS:Patients referred for KT to the Toronto General Hospital from January 1, 2003, to December 31, 2012, and who completed a social work assessment, were included (n = 1769). The association between the history of MH disorders or NA and the time from referral to WU completion or KT were examined using Cox proportional hazards models. RESULTS: A history of MH disorders or NA was present in 24% and 18%, respectively. Patients with MH disorders had a 17% lower adjusted hazard of completing the WU within 2 years of referral (HR 0.83; 95% confidence interval [95% CI], 0.71-0.97). Similarly, patients with a history of NA had a 21% lower hazard of completing the WU (hazard ratio [HR], 0.79; 95% CI, 0.66-0.94). The adjusted HR for KT was 0.88 (95% CI, 0.74-1.05) and 0.79 (95% CI, 0.64-0.97) for MH disorders and NA, respectively. CONCLUSIONS: These findings suggest that a history of MH disorders or NA is a potential barrier to KT. Whether targeted psychosocial support can improve access to KT for these patients requires further study.
Authors: David D Aufhauser; Allison W Peng; Douglas R Murken; Seth J Concors; Peter L Abt; Deirdre Sawinski; Roy D Bloom; Peter P Reese; Matthew H Levine Journal: Clin Transplant Date: 2018-06-25 Impact factor: 2.863
Authors: Karly A Murphy; John W Jackson; Tanjala S Purnell; Ashton A Shaffer; Christine E Haugen; Nadia M Chu; Deidra C Crews; Silas P Norman; Dorry L Segev; Mara A McAdams-DeMarco Journal: Clin J Am Soc Nephrol Date: 2020-05-07 Impact factor: 8.237