Evaluating resilience as a predictor of outcomes in lung transplant candidates

Yvonne Tran Bui, Matthew A. Hathcock, Roberto P. Benzo, Marie M. Budev, Satish Chandrashekaran, David B. Erasmus, Erika D. Lease, Deborah J. Levine, Karin L. Thompson, Bradley K. Johnson, Sheila G. Jowsey-Gregoire, Cassie C. Kennedy

Research output: Contribution to journalArticlepeer-review


Background: Resilience represents the capacity to adapt to adversity. Resilience can improve following behavioral interventions. We examined lung transplant candidates’ resilience as a novel predictor using the Connor-Davidson Resilience Scale (RISC-10). Methods: Waitlisted candidates at six centers were mailed questionnaires from 9/16/2015 to 10/1/2019. Follow-up surveys were collected annually and post-transplant. Outcomes were recorded through February 17, 2020. Primary outcome was pre-transplant death/delisting. Analyses included t test or chi-square for group comparisons, Pearson's correlation coefficients for strength of relationships, and Cox proportional-hazard models to evaluate associations with outcomes, adjusting for age, sex, and mood. Results: Participation was 55.3% (N = 199). Baseline RISC-10 averaged 32.0 ± 5.6 and did not differ by demographics, primary transplant diagnosis, or disease severity markers. RISC-10 did not correlate to the commonly utilized Psychosocial Assessment of Candidates for Transplant [PACT] or Stanford Integrated Psychosocial Assessment for Transplantation [SIPAT] tools. Scores < 26.3 (representing > 1 standard deviation below population average) occurred in 16% and were associated with pre-transplant death or delisting, adjusted Hazard Ratio of 2.60 (95% Confidence Interval 1.23-5.77; P =.01). Conclusion: One in six lung candidates had low resilience, predicting increased pre-transplant death/delisting. RISC-10 did not correlate with PACT or SIPAT; resilience may represent a novel risk factor.

Original languageEnglish (US)
Article numbere14056
JournalClinical Transplantation
Issue number10
StatePublished - Oct 1 2020


  • lung transplantation
  • mental health
  • psychological resilience

ASJC Scopus subject areas

  • Transplantation


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