PSYCHOSOCIAL EVALUATION AND PREDICTION OF COMPLIANCE PROBLEMS AND MORBIDITY AFTER HEART-TRANSPLANTATION

We examined prospectively determined psychosocial evaluation data in 1 25 consecutive adult patients undergoing heart transplantation from Ja nuary 1992 to April 1994 to determine their associations with morbidit y, mortality, and compliance. Prospective ratings included age, sex, w eight, education, social support, living arrangements, motivation, kno wledge and expectations about transplantation, intercurrent social str essors, substance abuse, personality disorder, cognitive impairment, o ther psychiatric disorders, and the evaluating psychiatrist's global a ssessment of psychosocial risk. Additional variables evaluated were su pport group attendance and waiting list time. We examined outcomes inc luding patient survival, compliance, episodes of rejection and infecti on, development of transplant coronary artery disease, number of misse d appointments, and maintenance of ideal body weight. The posttranspla nt follow-up period was 13.8+/-9.9 months (mean+/-SD). In univariate a nalyses, compliance problems were associated with substance abuse hist ory (P=.0007), personality disorder (P=.007), living arrangements (P=. 02), and global psychosocial risk (P=.001). The number of rejection ep isodes was associated with global psychosocial risk (P=.029), and tran splant coronary artery disease was inversely associated with education (P=.01). Survival was not associated with any of the predictor variab les. In stepwise multivariate analyses, the significant predictors of compliance were substance abuse (odds ratio 3.69, confidence limits 1. 07-12.71) and global psychosocial risk (odds ratio 3.76, confidence in tervals 1.18-11.97). These findings suggest that pretransplant evaluat ion of psychosocial risk factors can identify patients with increased risk of postoperative noncompliance and morbidity.