Psychosoziale Evaluation von Transplantationspatienten – Empfehlungen für die Richtlinien zur Organtransplantation

Zusammenfassung

Seit einigen Jahren befinden sich die Richtlinien zur Transplantationsmedizin der Bundesärztekammer in einem umfassenden Revisionsprozess. Der vorliegende Beitrag präsentiert Empfehlungen zur psychosozialen Evaluation von Patienten vor Organtransplantation, die von Experten der Kommission Psychologie/Psychosomatik der Deutschen Transplantationsgesellschaft erarbeitet wurden mit dem Ziel, diese Empfehlungen in die Richtlinien einzubringen. Wichtigstes Anliegen ist dabei die Etablierung einer obligatorischen psychosozialen Evaluation für alle Patienten vor Aufnahme in die Transplantationswarteliste. Beschrieben werden Inhalte, potenzielle Kontraindikationen und das Prozedere der Evaluation. Außerdem wird ausführlich die für die Untersucher für notwendig erachtete Qualifikation thematisiert. Abschließend wird der zukünftige Handlungsbedarf festgestellt.

Abstract

For the last few years, the German Medical Association’s guidelines for transplant medicine have been subject to an extensive revision process. The present contribution presents recommendations regarding the psychosocial evaluation of patients prior to organ transplantation, which were developed by experts from the Psychology/Psychosomatics committee of the German Transplant Society with the aim to incorporate the recommendations into the guidelines. The main objective is to establish a mandatory psychosocial evaluation for all patients prior to their admission to the transplant waiting list. Contents, potential contraindications, and the procedure of the evaluation are described. Furthermore, the qualification deemed necessary for the examiners is addressed in detail. Finally, the future need for action is determined.

Schlüsselwörter

Organtransplantation - Psychosoziale Evaluation - Empfehlungen

Key words

organ transplantation - psychosocial evaluation - recommendations

• Literatur

• 1 Chilcot J, Spencer BWJ, Maple H. et al. Depression and kidney transplantation. Transplantation 2014; 97: 717-721
• 2 DiMartini A, Crone C, Fireman M. et al. Psychiatric aspects of organ transplantation in critical care. Crit Care Clin 2008; 24: 949-981
• 3 Dobbels F, Skeans MA, Snyder JJ. et al. Depressive disorder in renal transplantation: an analysis of Medicare claims. Am J Kidney Dis 2008; 51: 819-828
• 4 Erim Y, Beckmann M, Klein C. et al. Psychosomatische Aspekte der Transplantationsmedizin. Psychother Psych Med 2013; 63: 238-249
• 5 Schulz KH, Kroencke S. Psychosocial challenges before and after organ transplantation. Transplant Research and Risk Management 2015; 7: 45-58
• 6 Corruble E, Barry C, Varescon I. et al. Depressive symptoms predict long-term mortality after liver transplantation. J Psychosom Res 2011; 71: 32-37
• 7 Corruble E, Barry C, Varescon I. et al. Report of depressive symptoms on waiting list and mortality after liver and kidney transplantation: a prospective cohort study. BMC Psychiatry 2011; 11: 182 doi:10.1186/1471-244X-11-182
• 8 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
• 9 DiMartini A, Dew MA, Chaiffetz D. et al. Early trajectories of depressive symptoms after liver transplantation for alcoholic liver disease predicts long-term survival. Am J Transplant 2011; 11: 1287-1295
• 10 Dobbels F, Vanhaecke J, Dupont L. et al. Pretransplant predictors of posttransplant adherence and clinical outcome: an evidence base for pretransplant psychosocial screening. Transplantation 2009; 87: 1497-1504
• 11 Havik OE, Siversten B, Relbo A. et al. Depressive symptoms and all-cause mortality after heart transplantation. Transplantation 2007; 84: 97-103
• 12 Novak M, Molnar MZ, Szeifert L. et al. Depressive symptoms and mortality in patients after kidney transplantation: a prospective prevalent cohort study. Psychosom Med 2010; 72: 527-534
• 13 Rogal SS, Mankaney G, Udawatta V. et al. Pre-transplant depression is associated with length of hospitalization, discharge disposition, and survival after liver transplantation. PLOS ONE 2016; 11: e0165517 doi:10.1371/journal.pone.0165517
• 14 Rosenberger EM, Dew MA, Crone C. et al. Psychiatric disorders as risk factors for adverse medical outcomes after solid organ transplantation. Curr Opin Organ Transplant 2012; 17: 188-192
• 15 Rosenberger EM, DiMartini AF, DeVito Dabbs AJ. et al. Psychiatric predictors of long-term transplant-related outcomes in lung transplant recipients. Transplantation 2016; 100: 239-247
• 16 Smith PJ, Blumenthal JA, Trulock EP. et al. Psychosocial predictors of mortality following lung transplantation. Am J Transplant 2016; 16: 271-277
• 17 Burra P, Germani G, Gnoato F. et al. Adherence in liver transplant recipients. Liver Transpl 2011; 17: 760-770
• 18 De Geest S, Dobbels F, Fluri C. et al. Adherence to the therapeutic regimen in heart, lung, and heart-lung transplant recipients. J Cardiovasc Nurs 2005; 20: S88-S98
• 19 Dew MA, DiMartini AF, De Vito Dabbs A. et al. Rates and risk factors for nonadherence to the medical regimen after adult solid organ transplantation. Transplantation 2007; 83: 858-873
• 20 Morrissey PE, Flynn ML, Lin S. Medication noncompliance and its implications in transplant recipients. Drugs 2007; 67: 1463-1481
• 21 Nerini E, Bruno F, Citterio F. et al. Nonadherence to immunosuppressive therapy in kidney transplant recipients: can technology help?. J Nephrol 2016; 29: 627-636
• 22 Nevins TE, Nickerson PW, Dew MA. Understanding medication nonadherence after kidney transplant. J Am Soc Nephrol 2017; 28: 2290-2301
• 23 Desmyttere A, Dobbels F, Cleemput I. et al. Noncompliance with immunosuppressive regimen in organ transplantation: is it worth worrying about?. Acta Gastroenterol Belg 2005; 68: 347-352
• 24 Denhaerynck K, Dobbels F, Cleemput I. et al. Prevalence, consequences, and determinants of nonadherence in adult renal transplant patients: a literature review. Transpl Int 2005; 18: 1121-1133
• 25 Dobbels F, Van Damme-Lombaert R, Vanhaecke J. et al. Growing pains: non-adherence with the immunosuppressive regimen in adolescent transplant recipients. Pediatr Transplant 2005; 9: 381-390
• 26 Dobbels F, Ruppar T, De Geest S. et al. Adherence to the immunosuppressive regimen in pediatric kidney transplant recipients: a systematic review. Pediatr Transplant 2010; 14: 603-613
• 27 Dew MA, DiMartini AF, Steel J. et al. Meta-analysis of risk for relapse to substance use after transplantation of the liver or other solid organs. Liver Transpl 2008; 14: 159-172
• 28 Duerinckx N, Burkhalter H, Engberg SJ. et al. Correlates and outcomes of posttransplant smoking in solid organ transplant recipients: a systematic literature review and meta-analysis. Transplantation 2016; 100: 2252-2263
• 29 Neuberger JM, Bechstein WO, Kuypers DR. et al. Practical recommendations for long-term management of modifiable risks in kidney and liver transplant recipients: a guidance report and clinical checklist by the Consensus on Managing Modifiable Risk in Transplantation (COMMIT) Group. Transplantation 2017; 101 (Suppl. 02) S1-S56
• 30 Taber DJ, Fleming JN, Fominaya CE. et al. The impact of health care appointment non-adherence on graft outcomes in kidney transplantation. Am J Nephrol 2017; 45: 91-98
• 31 Schulz KH, Kaller T, Kohlmann S. et al. Transplantationspsychologie. In: Koch U, Bengel J. Hrsg. Anwendungen der Medizinischen Psychologie (Enzyklopädie der Psychologie, Medizinische Psychologie Bd. 2). Göttingen: Hogrefe; 2017: 361-400
• 32 Haavisto A, Korkman M, Sintonen H. et al. Risk factors for impaired quality of life and psychosocial adjustment after pediatric heart, kidney, and liver transplantation. Pediatr Transplant 2013; 17: 256-265
• 33 Kaller T, Petersen I, Petermann F. Psychische Auffälligkeiten nach pädiatrischer Lebertransplantation. Monatsschr Kinderheilkd 2013; 161: 1169-1176
• 34 Anthony SJ, Annunziato RA, Fairey E. et al. Waiting for transplant: physical, psychosocial, and nutritional status considerations for pediatric candidates and implications for care. Pediatr Transplant 2014; 18: 423-434
• 35 Cousino MK, Rea KE, Schumacher KR. et al. A systematic review of parent and family functioning in pediatric solid organ transplant populations. Pediatr Transplant 2017; 21: e12900 doi:10.1111/petr.12900
• 36 Jowsey SG, Taylor ML, Schneekloth TD. et al. Psychosocial challenges in transplantation. J Psychiatr Pract 2001; 7: 404-414
• 37 Twillman RK, Manetto C, Wellisch DK. et al. The Transplant Evaluation Rating Scale. A revision of the psychosocial levels system for evaluating organ transplant candidates. Psychosomatics 1993; 34: 144-153
• 38 Johann B, Lorenzen J. Die Psychosomatische Evaluation von Lebertransplantationspatienten – Anwendungsmöglichkeiten der Transplant-Evaluation-Rating-Scale. In: Johann B, Erhard J. Hrsg Psychosomatische Betreuung von Transplantationspatienten. Lengerich: Pabst; 1997: 43-53
• 39 Bundesärztekammer (BÄK). Richtlinien zur Organtransplantation gem. § 16 TPG. Richtlinie gemäß § 16 Abs. 1 S. 1 Nrn. 2 u. 5 TPG für die Wartelistenführung und Organvermittlung zur Lungentransplantation. Dtsch Arztebl 2017; 114: A1948; www.aerzteblatt.de/pdf. asp?id = 194041