背景:由于日本的大多数肾移植都是在活体供体的基础上进行的,移植后的结果应该达到最佳效果,克服参与者可能降低的依从性。这项研究调查了日本版本的斯坦福移植综合心理社会评估(SIPAT-J)与结果之间的关联。患者活体肾移植(LKT)后一年。
方法:前瞻性队列研究于2020年1月至2021年7月在东京女子医科大学医院进行,随访期为一年。SIPAT-J评估了18种心理社会危险因素:(A)患者的准备水平和疾病管理(SIPATA),(B)社会支持系统准备水平(SIPATB),(C)心理稳定性和精神病理学(SIPATC),和(D)生活方式和物质使用效果(SIPATD)。评估人员,一个精神病医生和三个临床心理学家,进行独立,使用参与者的医疗记录对SIPAT-J进行盲化应用。这项研究的重点是物理复合结果,精神病学结果,和不遵守的行为。
结果:参与者为173名LKT接受者(中位年龄(IQR)51(38-59));67.1%为男性,67.1%受雇。中位数(IQR)SIPAT评分为SIPATA[7(5-9)],SIPATB[7(5-9)],SIPATC[2(0-4)],SIPATD[3(3-4)],和SIPAT总计[20(16-23)]。物理复合结局为25(14.5%),精神病学结果9(5.2%),和非粘附行为17(9.8%)。SIPATC(比值比[OR]=1.34,95%置信区间[Cl]=1.06-1.72,p=0.02)与精神病预后显着相关。SIPATB(OR=1.49,95%Cl=1.12-1.98,p=0.01)和SIPAT总计(OR=1.13,95%Cl=1.03-1.24,p=0.01)与非粘附行为显着相关。SIPAT与物理复合结局之间没有显着关联。
结论:这项研究首次检查了SIPAT与LKT后一年的身体和精神结局之间的关系,控制随访期和SIPAT以外的因素。在LKT之前进行全面的社会心理评估,并及早发现可能对移植成功产生负面影响的因素,可以实施有针对性的干预措施,并增加获得有利受体结果的可能性。
BACKGROUND: Because most kidney transplantations in Japan are performed on the basis of living donors, after-transplant outcomes should achieve optimum results, overcoming participants\' possible reduced adherence.
OBJECTIVE: To investigate the association between the Japanese version of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT-J) and outcomes, 1 year after the patient\'s living kidney transplant (LKT).
METHODS: The prospective cohort study was undertaken at Tokyo Women\'s Medical University Hospital from January 2020 to July 2021, with a 1-year follow-up period. The SIPAT-J assesses 18 psychosocial risk factors: (1) Patient\'s Readiness Level and Illness Management (SIPAT A), (2) Social Support System Level of Readiness (SIPAT B), (3) Psychological Stability and Psychopathology (SIPAT C), and (4) Lifestyle and Effect of Substance Use (SIPAT D). The evaluators, a psychiatrist and 3 clinical psychologists, conducted an independent, blinded application of the SIPAT-J using participants\' medical records. The study focused on physical composite outcomes, psychiatric outcomes, and nonadherent behaviors.
RESULTS: The participants were 173 LKT recipients (median age [interquartile range], 51 [38-59]); 67.1% were male and 67.1% were employed. The median (interquartile range) SIPAT scores were SIPAT A [7 (5-9)], SIPAT B [7 (5-9)], SIPAT C [2 (0-4)], SIPAT D [3 (3-4)], and SIPAT total [20 (16-23)]. The physical composite outcome was 25 (14.5%), psychiatric outcome 9 (5.2%), and nonadherent behavior 17 (9.8%). SIPAT C (odds ratio = 1.34, 95% confidence interval = 1.06-1.72, P = 0.02) was significantly associated with the psychiatric outcome. SIPAT B (odds ratio = 1.49, 95% confidence interval = 1.12-1.98, P = 0.01) and SIPAT total (odds ratio = 1.13, 95% confidence interval = 1.03-1.24, P = 0.01) were significantly associated with nonadherent behaviors. There was no significant association between the SIPAT and physical composite outcomes.
CONCLUSIONS: This study is the first to examine the association between SIPAT and physical and psychiatric outcomes 1 year after LKT, controlling for follow-up periods and factors other than SIPAT. Comprehensive psychosocial assessment before LKT and early identification of factors that may negatively affect transplant success can allow targeted interventions to be implemented and increase the likelihood of favorable recipient outcomes.