Abstract: TH-PO956
PACT Score Identifies Nonadherence and Acute Rejection in Pediatric Renal Transplantation
Session Information
- Live Donor Outcomes and Kidney Transplantation in Pediatric and Ethnic/Racial Groups
November 02, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
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 Age | 12.17 (8.19, 15.97) | 14.74 (8.47, 16.98) | 13.53 (9.11, 16.69) | 0.866 |
| Male | 25.0% ( 1) | 70.0% (14) | 67.6% (25) | 0.206 |
| Female | 75.0% ( 3) | 30.0% ( 6) | 32.4% (12) | |
| African American | 25.0% ( 1) | 44.4% ( 8) | 44.8% (13) | 0.115 |
| Caucasian | 25.0% ( 1) | 38.9% ( 7) | 48.3% (14) | |
| Hispanic | 50.0% ( 2) | 5.6% ( 1) | 3.4% ( 1) | |
| Other | 0.0% ( 0) | 11.2% ( 2) | 3.4% ( 1) | |
| BMI | 25.00 (13.75, 33.25) | 22.50 (12.75, 37.25) | 28.00 (15.00, 42.00) | 0.7 |
| HLA Mismatch | 2.0 (2.0, 2.5) | 2.0 (2.0, 3.5) | 4.0 (2.5, 5.5) | 0.004 |
| Cyclosporine | 0.0% ( 0) | 0.0% ( 0) | 8.1% ( 3) | 0.359 |
| Steroids | 100.0% ( 4) | 100.0% (20) | 91.9% (34) | 0.359 |
| Cellcept/Myfortic | 50.0% ( 4) | 47.5% (19) | 41.9% (31) | 0.8 |
| Tacrolimus | 100.0% ( 4) | 100.0% (20) | 75.7% (28) | 0.033 |
| Azathioprine | 0.0% ( 0) | 10.0% ( 2) | 8.1% ( 3) | 0.801 |
Clinical Outcomes by PACT Score