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. 2023 Jun 16;120(24):413-416.
doi: 10.3238/arztebl.m2023.0087.

Psychosocial Diagnosis and Treatment Before and After Organ Transplantation

Martina de Zwaan  1 , Yesim Erim, Sylvia Kröncke, Frank Vitinius, Angela Buchholz, Mariel Nöhre; guideline group “Psychosocial Diagnosis and Treatment of Patients before and after Organ Transplantation”*
Affiliations

Psychosocial Diagnosis and Treatment Before and After Organ Transplantation

Martina de Zwaan et al. Dtsch Arztebl Int. .

Abstract

Background: This new clinical practice guideline concerns the psychosocial diagnosis and treatment of patients before and after organ transplantation. Its objective is to establish standards and to issue evidence-based recommendations that will help to optimize decision making in psychosocial diagnosis and treatment.

Methods: For each key question, the literature was systematically searched in at least two databases (Medline, Ovid, Cochrane Library, and CENTRAL). The end date of each search was between August 2018 and November 2019, depending on the question. The literature search was also updated to capture recent publications, by using a selective approach.

Results: Lack of adherence to immunosuppressant drugs can be expected in 25-30% of patients and increases the odds of organ loss after kidney transplantation (odds ratio 7.1). Psychosocial interventions can significantly improve adherence. Metaanalyses have shown that adherence was achieved 10-20% more frequently in the intervention group than in the control group. 13-40% of patients suffer from depression after transplantation; mortality in this group is 65% higher. The guideline group therefore recommends that experts in psychosomatic medicine, psychiatry, and psychology (mental health professionals) should be involved in patient care throughout the transplantation process.

Conclusion: The care of patients before and after organ transplantation should be multidisciplinary. Nonadherence rates and comorbid mental disorders are common and associated with poorer outcomes after transplantation. Interventions to improve adherence are effective, although the pertinent studies display marked heterogeneity and a high risk of bias.

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Figures

eFigure
eFigure
Flow chart on key questions 1–3 (4)
See this image and copyright information in PMC

References

    1. Schulz KH, Kroencke S. Psychosocial challenges before and after organ transplantation. Transplant Research and Risk Management. 2015;7:45–48.
    1. Dew MA, Rosenberger EM, Myaskovsky L, et al. Depression and anxiety as risk factors for morbidity and mortality after organ transplantation: a systematic review and meta-analysis. Transplantation. 2015;100:988–1003. - PMC - PubMed
    1. Zimbrean PC. Depression in transplantation. Curr Opin Organ Transplant. 2022;27:535–545. - PubMed
    1. Deutsche Gesellschaft für Psychosomatische Medizin und Ärztliche Psychotherapie e.V. (DGPM), Deutsches Kollegium für Psychosomatische Medizin e.V. (DKPM) Psychosoziale Diagnostik und Behandlung von Patientinnen und Patienten vor und nach Organtransplantation. https://register.awmf.org/de/leitlinien/detail/051-031 (last accessed on 25 May 2023)
    1. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. Das AWMF Regelwerk Leitlinien. https://www.awmf.org/regelwerk/. (last accessed on 06 January 2023)