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Abstract: TH-PO956

PACT Score Identifies Nonadherence and Acute Rejection in Pediatric Renal Transplantation

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Freischlag, Kyle, Duke University School of Medicine, Durham, North Carolina, United States
  • Chen, Vivian M, Duke University , Durham, North Carolina, United States
  • Nagaraj, Shashi K., Duke University , Durham, North Carolina, United States
  • Chua, Annabelle N., Duke University , Durham, North Carolina, United States
  • Tsai, Eileen W., Duke University , Durham, North Carolina, United States
Background

In this pilot study, we examined the utility of a pre-transplant Psychosocial Assessment of Candidates for Transplantation (PACT) score to identify at-risk pediatric patients.

Methods

Patients were <21 year-old renal transplant recipients at our institution between 2005 and 2017. Pre-transplant psychosocial evaluation was standardized in 2011 utilizing PACT scores to assesses candidates (0-5) on social support, psychological health, lifestyle factors, and understanding. Demographics and clinical outcomes were analyzed by low PACT score (≤2), high PACT score (≥3), and no PACT score.

Results

61 pediatric patients were identified: 7% low PACT score, 33% high PACT score, and 61% no PACT score (Table 1). High PACT scores were associated with lower rates of medical non-adherence (Low 75% vs High 15% vs No 51.4%, p=0.01) and acute rejection (0% vs 20% vs 50.0%,p=0.025) (Figure 1). Controlling for HLA mismatch, PACT score reduced (OR 0.15 95% CI 0.03-0.83) while non-adherence increased (OR 5.72 95% CI 1.35-24.28) the chances of acute allograft rejection.

Conclusion

PACT was associated with less medical non-adherence and fewer incidences of acute rejection. Our study highlights PACT score in risk stratifying candidates, which warrants prospective validation.

Patient Demographics by PACT Score
 Low PACT (N=4)High PACT (N=20)No PACT (N=37)P-value
Transplant Age12.17 (8.19, 15.97)14.74 (8.47, 16.98)13.53 (9.11, 16.69)0.866
Male25.0% ( 1)70.0% (14)67.6% (25)0.206
Female75.0% ( 3)30.0% ( 6)32.4% (12) 
African American25.0% ( 1)44.4% ( 8)44.8% (13)0.115
Caucasian25.0% ( 1)38.9% ( 7)48.3% (14) 
Hispanic50.0% ( 2)5.6% ( 1)3.4% ( 1) 
Other0.0% ( 0)11.2% ( 2)3.4% ( 1) 
BMI25.00 (13.75, 33.25)22.50 (12.75, 37.25)28.00 (15.00, 42.00)0.7
HLA Mismatch2.0 (2.0, 2.5)2.0 (2.0, 3.5)4.0 (2.5, 5.5)0.004
Cyclosporine0.0% ( 0)0.0% ( 0)8.1% ( 3)0.359
Steroids100.0% ( 4)100.0% (20)91.9% (34)0.359
Cellcept/Myfortic50.0% ( 4)47.5% (19)41.9% (31)0.8
Tacrolimus100.0% ( 4)100.0% (20)75.7% (28)0.033
Azathioprine0.0% ( 0)10.0% ( 2)8.1% ( 3)0.801

Clinical Outcomes by PACT Score