Psychosocial Risk Impacts Mortality in Women After Liver Transplantation

Terry D. Schneekloth, Mario J. Hitschfeld, Tanya M. Petterson, Praveena Narayanan, Shehzad K. Niazi, Sheila G. Jowsey-Gregoire, Nuria J. Thusius, Adriana R. Vasquez, Walter K. Kremers, Kymberly D. Watt, Teresa A. Rummans

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background: Liver transplant candidates undergo psychosocial assessment as a component of their pretransplant evaluation. Global psychosocial assessment scales, including the Psychosocial Assessment of Candidates for Transplantation (PACT), capture and quantify these psychiatric and social variables. Objective: Our primary aim was to assess for an association between global PACT score and survival in liver transplant recipients. Methods: This retrospective cohort study examined records of all liver recipients at one U.S. Transplant Center from 2000 to 2012 with outcomes monitoring until 07/01/2016. We investigated for associations between the following variables and mortality: PACT score, age, gender, marital status, race, alcoholic liver disease (ALD), and body mass index (BMI). Statistical methods included Student's t-test, Wilcoxon rank sum test, chi-square, Fisher's exact test, Kaplan–Meier curve, and Cox proportional hazard models. Results: Of 1040 liver recipients, 538 had a documented PACT score. Among these, PACT score was not associated with mortality. In women, a lower PACT score was associated with mortality (p = 0.003) even after adjustments for age, marital status, and BMI. Women with ALD had a 2-fold increased hazard of death (p = 0.012). Increasing age was associated with increased risk of death for the cohort as a whole (p = 0.019) and for men (p = 0.014). In men, being married and BMI were marginally protective (p = 0.10 and p = 0.13, respectively). Conclusions: Transplant psychosocial screening scales, specifically the PACT, identify psychosocial burden and may predict post-transplant outcomes in certain populations. In female liver recipients, lower PACT scores and ALD were associated with a greater risk of post-transplant mortality.

Original languageEnglish (US)
Pages (from-to)56-65
Number of pages10
Issue number1
StatePublished - Jan 1 2019


  • Outcome
  • PACT
  • PACT score
  • Sex differences
  • liver transplantation
  • psychosocial
  • women, mortality

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Applied Psychology
  • Psychiatry and Mental health


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